Sapala/Wood Micropouch

I am wanting to hear from people that have had the Sapala/Wood Micropouch. I am 6 yrs out and am gaining weight. I am doing some research about this. I found out some interesting information this weekend ...4 other people that have had it ,all gained ALL the weight back and then some..so please tell me your experience and how far out you are and which Dr. you had do your surgery. You can e-mail me privately and i will keep your name confidential..Thank you for any help you can give Val

Hi Val. I dont actually have the micropouch i was a cancellation away from getting it done. If you read my profile you will see what i think about the Cori centers and their damn micropouch. I know that they lie. I know that when i went to the seminar they prided themselves on the fact that in all the years they have been doing the micropouch they have never had to go back in a do a revision for weight gain. True or not?? I dont know, i sure believed them. I was given the run around do many times from them that i started doubting everything they told me. I am sorry you are having trouble gaining weight back. I wouldnt worry about the others who have gained their weight back. Just focus on yourself. I know you have been through alot with your job these last few weeks and we are human. Stress causes bad habbits to creep back. Call the cori centers and use the nutrionist. You still have a great tool in place. You are a great support for others on this board i see that all the time in the main room. Use us now. Everyone is here for you. Make the cori centers do follow up care. You have to be on top of them. Email me anytime. LisaMarie

Hi Val I am kinda new on this board. Can I tell you??, I just read over your whole profile. Wow. You are some special person, and you sound like so much fun. I want to tell you I can see how special your mom was by the way you are! God Bless You Val. I hope you begin loosing again, hope you get your surgery if that is what you find you need. I have a feeling you are strong and determined so that you will be able to do it if it can be done! Anytime you want to talk, about anything you just email me okay? By the way I am pre op still, but should be getting a surgery day soon. I am hoping to get a sleeve gastrectomy. We will see. Thurs. I have my last consult with the nutritionist and I am going in to see my dr to tell him which surgery I decided on. Wish me luck. Hope to talk with you again! Tami

Val" I can not give you the exact help you're looking for but perhaps some info that may help you. I am a regualr Lap RNY Bypass, proximal 100cm bypass w/15cc pouch. (*note for anyone reading make sure you get a copy of your surgical report so you KNOW what your surgery really was just in case you ever need it for a revision etc!, call hospital Medical records your entitled to it!) First there can be REGAIN with ANY surgery, they are all less than perfect, they are all only a tool, and even if they are intact body really tries to adapt, and well we are human and don't always do what we should w/ diet/exercise!. This is not always the fault of the surgeon, patient or procedure. There are quite a few reasons (may involve one or all of previous).... Before I talk about that consider joining this group for information on regain as well as another on revisions. http://health.groups.yahoo.com/group/OSSG_Off_track/ http://groups.yahoo.com/group/Graduate-OSSG/ (for members > 1yr postop!) http://health.groups.yahoo.com/group/WLSrevisionsupport/ I belong to all 3 and knowledge is power! I also co own the offtrack group, with over 1,600 on that I can tell you there is A LOT of regain with any surgery postop!.... What are your issues/ideas/thoughts on why for you no more wt loss or regain? I ask because I think the solution/recommendations may be different depending on your answers.... 3 things may be happening independent or together: · Broken Surgery · Behavioral issues (not using tool) · Wrong tool/surgery OK: #1) BROKEN SURGERY: (I think all sapala woods are a transected pouch...?) http://www.weightlosssurgery.com/moremicropouch.html WERE YOU Open or Lap? Were you transected (pouch and distal unused stomach severed by staples and cut by space?) IF not maybe the issue is a staple line disruption/failure (AKA SLD)...food is going into the old tummy and no malabsorbtion is happening. Or a fistuala ("A gastro-gastric fistula is simply a communication between thenew "pouch" and the "old" stomach.)*Same as SLD your getting food into distal stomach. and it avoids the bypass. Have you had an upper GI endoscopy? (Scope down throat) to see if pouch is intact and how large your stoma is (connection of pouch and intestines). Many have an enlarged stoma allowing them to eat larger quantities w/o feeling full, kinda like a shute. This is usually not patients or surgeons fault but many pts stomas relax on them...A lap band may help here or a surgical revisionof stoma or a fixed silastic ring, but it isnt always possible. Also many are using sclerotherapy they say for this (inject substance thru upper gi into tissue to produce scarring) *see file section on this also I just uploaded 2 files on it that I have on revision group I posted above. Do you get full? How much food? Have you done the cottage cheese test? (in files of offtrack group) #2) BEHAVIORAL (not using tool to potential): I am not saying it is behavioral just asking a few ? here: What do you eat in a given day? Calories track on www.fitday.com % fat/protein/carbs. Do you drink with meals? Drink calories? Soda? Do you do protein shakes? (type/number) Do you do vitamins? Which ones? When were your last full set of labs/Dexascan? (See file section for a list) Do you exercise? How often? Amount? Type? What other meds are you on? Medcial conditions? Age, Height? Starting BMI Current BMI. (Basically looking for % of excess you lost) Do you follow pouch rules? http://www.digitalhorsewoman.com/pouchrules.htm We can eat more at 6 mo out (quantity and types), it is also time malabsorbtion of calories decreases for many as body adapts. OKAY the above questions are just to help us figure out some potential behavioral issues. Again I am NOT saying the failure of you or anyone is strictly behavioral. It is just one thing. Any surgery can be defeated if the tool isn't used, BUT if the tool is used reasonably it may be broke or may of been the wrong tool (surgery) for you! #3) WRONG SURGERY: We do not always know this until after. Some surgeons realize the higher the BMI of the patient the more distal they should be. Or the type of eater someone is may lend itself to one surgery over another. Some fail to lose wt with a VBG or lap band only to lose well with a RNY or many with a proximal RNY fail to lose wt and do great with a distal RNY or others dont do well with rny and do fantastic with a BPD/DS...you get my point. One surgeon had this to say about choosing your surgery type for you. (*I am not sure there is any real one size fits all though on deciding!) http://www.alagsa.com/Bariatric_Surgery.htm They (?) say 50% of excess wt lost is a successful surgery. I agree *but why accept this? when others lose 75, 80, 90, 100%? I know everyone is different but if there are means to allow most to lost 80+ % why shouldnt everyone have the opportunity? We all have to weigh the pros and cons. Going BPD/DS or more distal has risks, a lap band has risks etc. Many lose 80%+ and regain after 1, 2, 3 ,5 yrs. Not always behavioral or mechanical,,,,so their body is real good at adapting and hence they probably had wrong surgery....The adaption people discuss is the intestines try and compensate for malabsorbtion by elongation, increasing folds for absorbtion and increase in villi to absorb nutrients! It is a proven fact this happens (seen when they open people up!) many feel refeeding w/ protein shakes avoids this hypertrophy..so body doesnt have to adapt!... I hope this helps some and doesnt really confuse you. I have to add, I haven't had a revision. I am here learning with everyone "IN CASE" (I think education is key to success and all I can arm myself with!). It (regain) scares me too! I see/read/hear about wt regain more and more online and read more about revisions. WLS has come a long way, but maybe just maybe some day we'll get the right surgery the first time! One that we can behaviorally adapt to and use and that wont break! ONE CAN DREAM! I am also adding document below on eval for wt loss failure I cant recall source sorry! ~~~~~~~~~~~~~~~~~~~~~~~ EVALUATION FOR WEIGHT LOSS FAILURE Evaluating a patient who is progressively regaining weight can be relatively simple - or difficult. The first principle is to determine that the gastric pouch is anatomically intact. If it is not intact, it should be made intact by a revision procedure. Only when the surgeon can be reassured that the pouch in intact does the complex part begin - evaluating how and why the patient is not using the pouch/tool properly, and/or getting a reasonable amount of exercise. We need to know three things about the small gastric pouch. First, is the staple line intact; second, is the outlet intact; and third, is the pouch reasonably small in size. The upper GI series is the basic tool for evaluating intactness of the staple line and the outlet. If the pouch has been stapled in continuity with the rest of the stomach (non-transected), we must confirm that the staple line remains intact. A disruption of the staple line will create two gastric outlets leading to rapid pouch emptying, early loss of satiety, and thus early return of hunger. The upper GI series can usually give the bariatric surgeon a reliable view of the diameter of the gastric outlet also. A diameter of over 18-20 mm is usually associated with weight regain. Outlet failure, like a staple line disruption, causes rapid emptying of the pouch and early loss of satiety, and early return of hunger. On the other hand, weight regain can occur as a result of an outlet diameter under 7-8 mm which can lead to persistent vomiting of solid foods and gradual persuasion of the patient towards the Soft Calorie Syndrome with resultant rapid pouch emptying, early loss of satiety, early return of hunger, and regain. The upper GI series is less effective for evaluating pouch volume because of the fact that barium is very much of a liquid. To assess pouch volume, you must turn to the patient's history of the size of the meal that he/she can consume within a short five to fifteen minute time frame, and/or the Cottage Cheese Test. Cottage Cheese Test: Measure out a couple 1/2cup servings of cottage cheese. See how much cottage cheese you can eat until you are full (Eat it at a regular pace. It should only take a short time.) The amount you eat until just full is approximately the size of your pouch. Up to 4-6 ounces should be considered average. (1/2 C equals 4 ounces) In the patient whose gastric pouch seems to be anatomically intact and yet he/she is still regaining weight, the evaluation becomes more complex. The usual finding is that the patient is not following the principles of the use of their pouch/tool and/or is exrtremely inactive physically. There are four problems that occur with some frequency: · The patient has never been taught/ or does not understand how to use the tool. · The patient is significantly depressed. · Loss of contact with a bariatric practice or other bariatric patients and a gradual erosion of following the principles. · The patient is truly noncompliant and will not take responsibility for his/her own behavior. PATIENT DOESN'T UNDERSTAND HOW TO USE THIS TOOL Patient needs teaching on use of pouch/tool and proper eating habits after gastric bypass surgery. Also attendance at a good bariatric support group is extremely important DEPRESSION Depression is a powerful inhibiter of success after bariatric surgical procedures. A small but significant number of patients have been doing well following surgery only to drop out of sight for a time and then reappear with a significant weight regain. Upon evaluating these patients, it would appear that in many instances they seemingly deliberately reverse all of their learned principles of the use of their pouch/tool: grazing and snacking through much of the day, drinking high calorie liquids, drinking liquids with meals, and stopping their exercise, even when they are intellectually aware that exercise in itself releases numerous vasoactive substances which act like antidepressants. What can be done when a bariatric patient obviously is depressed and regaining weight? Obviously, the most important thing is to steer them to professional counseling, if they are not already in counseling. Then, be encouraging. We can encourage them to continue to use the tool as best as they can; we can encourage them to return to exercise which will improve their spirits and reassure them that the improvement is "deserved," because they really are a good person and deserve to feel better..." Most of all, they need to be reassured that the pouch/tool is not ruined by this overeating and gradual weight regain. When they are ready once again to use their pouch/tool, it will be there for them, and they will be able to once again lose weight without being hungry. EROSION OF THE USE OF THE PRINCIPLES In a third subset of weight maintenance failure patients, a subtle weight creep can occur in patients who are otherwise compliant, non-depressed, and have intact pouches. The patient will see it as "struggling" with his/her weight, and by definition, he/she will not have seen their bariatric surgeon for followup visits, and will have usually lost contact with a support group or other bariatric surgical patients. There seems to be a progressive erosion of following the principles of the pouch/tool. This may be due to denial as seen in diabetic patients, or it may be due to the influence of their peer group and the fact that some of the principles of the use of the pouchtool, especially fluid management, are counter-intuitive and counter to behavior of their peer group. The patient will often not come back for evaluation because "I know what I'm doing is wrong!" (meaning that he/she is eating the wrong things and too often), and these patients will internalize their "failure" with an increasing sense of guilt which itself acts as an inhibition to coming back to their surgeon's office or support group for help. These patients are in need of a "refresher course" in the use of the principles of the pouch/tool. In the first three examples of reasons for failure - lack of teaching, depression, and gradual erosion of the use of their tool, weight once regained can be lost once again if the pouch is anatomically intact and the patient decides to use it, or learn how to use it or relearns how to use it. In these three examples we are working with compliant, reasonably responsible persons who, when they can, are willing to take responsibility for their own behavior. TRUE NON-COMPLIANCE The most difficult problem is determining, and being comfortable with that determination, when a patient is being fundamentally noncompliant and obstructive. This type of individual may leave his/her surgeon's care and go to others complaining about a "personality conflict", or perhaps even that the surgeon has not given them the time and attention that they need and deserve. Inexplicably, some will actually stay with their surgeon. In this instance, when the patient tends to return perhaps even more frequently than usual, depression will be more likely the underlying mechanism rather than noncompliance. It can be difficult to be reasonably sure of what is going on in one or two visits. The truly noncompliant patient will very likely end up with multiple revisions and/or a reversal due to weight regain or complications. This is not to say that someone with multiple revisions and/or a reversal necessarily is noncompliant. The kind of patient who is truly noncompliant is often quite resistant to counseling, but no other management option offers much hope for success. Luckily, this type of patient represents a very small minority of patients. ~~~~~~~~~~~~~~~~~ Take Care, if you read this far also feel free to email me off list ok! [email protected] Jamie Ellis RN MS NPP Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

forgot to send this also! 'Outeating' Weight-Loss Surgery: High-Calorie Grazing Negates Results The Wall Street Journal February 24, 2004 HEALTH JOURNAL By TARA PARKER-POPE Celebrities like Al Roker and singer Carnie Wilson have fueled an unprecedented boom in weight-loss surgery. But for many patients, the procedure doesn't live up to the hype. A small but significant number of patients who have weight-loss surgery regain much or all of their weight back after a few years. Despite anatomical changes that make it impossible to binge or eat large quantities of food, some patients learn to "outeat" the surgery, grazing on small portions of high-calorie foods throughout the day. Other patients lose only a fraction of the weight expected and remain significantly overweight following the surgery. No one knows for sure how common the problem is, but estimates of these "failures," as they are known among surgeons, range from 5% to 20% of patients. Some experts worry that the problem may be growing as new weight-loss centers attempt to cash in on the surgical boom without offering patients long-term psychological and nutrition counseling. "It's a problem we really can't put our hands around right now," says San Diego surgeon Alan C. Wittgrove, president of the American Society for Bariatric Surgery. "We know there is a portion of the patient population that will not be successful....Sometimes the operation fails them, but sometimes they fail the operation." Because of growing concerns about quality control and long-term patient success rates, the society is pushing a new plan to be launched in about six weeks that will designate "centers of excellence" for weight-loss surgery, similar to those that already exist for cardiac care and organ transplants, says Walter J. Pories, a long-time bariatric surgeon and past-p resident of the ASBS. To qualify as a center of excellence, a surgeon or weight-loss center must document long-term patient results, physician expertise in surgical procedures and a multidisciplinary approach that offers patients long-term access to nutrition and psychological counseling and follow-up care. Bariatric surgery, typically performed in obese patients who are at least 100 pounds overweight, is still the only proven long-term method for significant weight loss. The most common form of gastric bypass surgery, which both shrinks the stomach and routes food past much of the digestive system, helps most patients lose 50% to 70% of their excess body weight and keep it off for years. In the vast majority of patients the surgery also helps eliminate diabetes, hypertension and a number of other health problems associated with obesity. EXTRA HELP Here's a look at some resources for patients considering weight-loss surgery. * www.asbs.org1: Links to surgeons and other information from the American Society for Bariatric Surgery * www.wlsguide.com2: Medical illustrations and other tips from the Doctor's Guide to Weight Loss Surgery, co-written by New York bariatric surgeon Louis Flancbaum * www.obesityhelp.com3: Chat room, clothing exchange and other resources * www.wlslifestyles.com4: Magazine for weight-loss-surgery patients * www.obesitysurgery.com5: Online search and purchase of articles from bariatric medical journal But while surgery helps control the quantity of food consumed, most patients are still plagued by the same eating demons that caused them to gain weight in the first place. In one study, 80% of patients reported that they regularly felt a loss of control over eating just six months after surgery. Several studies show that beginning two years after surgery, many patients begin to regain at least some of their weight. In a small percentage of patients, the weight regain will be excessive. Some patients regain the weight by drinking sweetened soft drinks, juices or milkshakes, or by grazing on crackers and dollops of peanut butter. But the problem may be widely under-reported because many patients are simply too ashamed to tell their doctors they are again struggling with their weight. That's what happened to 29-year-old Beverly Popolo of Clairton, Pa., who had stomach-stapling surgery about 10 years ago. After losing 80 pounds, she returned to overeating, and regained the lost weight and ended up 70 pounds heavier than she was before the surgery. "I felt like I was a failure," says Ms. Popolo. "I screwed up my only chance." But doctors in Pittsburgh agreed to do a gastric bypass after Ms. Popolo proved she was committed to making the needed lifestyle changes. Unlike with the first surgery, she met with nutrit ionists and underwent a psychological evaluation. Two years later, after intense counseling and the help of a support group, she has dropped 190 pounds and feels more confident about maintaining her weight. Last year, doctors performed about 100,000 procedures, up from an estimated 40,000 in 2001. While top weight-loss doctors report long-term results in major medical journals, nobody is tracking the results of the vast majority of patients who undergo surgery. But doctors are reporting anecdotal evidence of patients who come to them complaining that their first doctor didn't provide any care other than the initial surgery. "It's not automatic -- people have to be taught," says Madelyn H. Fernstrom, director of the University of Pittsburgh's weight-management center. Some doctors think a new gastric banding procedure approved by the FDA in 2001 may be compounding the problem. The procedure, which uses an adjustable and removal silicone band to shrink the stomach, is cheaper, less risky and easier to perform. But in the U.S., the band procedure also has resulted in less-impressive weight loss than gastric-bypass surgery. Critics say the problems are due in part to the nature of the procedure, which doesn't include bypassing intestines where food is absorbed. But they also blame a lack of follow-up and counseling. In U.S. studies, patients who were given the banding procedure lost less than 40% of their excess weight three years after surgery. Inamed, the Santa Barbara, Calif.-based maker of the gastric band, says the band has produced better results in other countries, possibly because of a stronger emphasis on lifestyle changes. More recently, results in the U.S. have improved, with patients losing about 50% of their extra pounds, says an Inamed spokesman. URL for this article: http://online.wsj.com/article/0,,SB107757061706636894,00.html Hyperlinks in this Article: (1) http://www.asbs.org (2) http://www.wlsguide.com (3) http://www.obesityhelp.com (4) http://www.wlslifestyles.com (5) http://www.obesitysurgery.com Jamie