looking for information regarding revision vs selective vagotomy
I have a non-healing anastomotic ulcer three and one half years after proximal RNY. With that exception I have been very lucky with no complications. I do have an extrodinarily large pouch that I have been complaining about since about 3 months out.
This ulcer has caused enough pain that I have been to the ER twice in the past three months. It has not bled that we are aware of. I have had three EGDs and have tried 3 different medications. My surgeon keeps a close eye on me and he practices at a center of excellence. He is starting to talk about exploring a surgical fix.
He is discussing two options.
Option number one is a selective vagotomy done with video assisted thoroscopy. It is done by a cardiothoracic surgeon who I actually work with. It has the shortest hospital stay and the shortest time off work.
Option number two is a revision of my RNY. He said that basically he would resect the pouch making it smaller and redo the anastomosis. There is some indication that marginal and anastomotic ulcers are more common with the larger pouches. This option might correct the huge pouch and hunger issues as well as the ulcer. It requires longer off of work and hospitalization. The surgeon says that about 50% of the time he ends up having to open instead of lap due to adhesions.
What can anyone tell me about the advantages and disadvantages of these two options? What potential complications and side effects can either of them give me? I want to go into this as educated as possible. I have tried reading medical journals but want to hear from survivors and people in the trenches.
This ulcer has caused enough pain that I have been to the ER twice in the past three months. It has not bled that we are aware of. I have had three EGDs and have tried 3 different medications. My surgeon keeps a close eye on me and he practices at a center of excellence. He is starting to talk about exploring a surgical fix.
He is discussing two options.
Option number one is a selective vagotomy done with video assisted thoroscopy. It is done by a cardiothoracic surgeon who I actually work with. It has the shortest hospital stay and the shortest time off work.
Option number two is a revision of my RNY. He said that basically he would resect the pouch making it smaller and redo the anastomosis. There is some indication that marginal and anastomotic ulcers are more common with the larger pouches. This option might correct the huge pouch and hunger issues as well as the ulcer. It requires longer off of work and hospitalization. The surgeon says that about 50% of the time he ends up having to open instead of lap due to adhesions.
What can anyone tell me about the advantages and disadvantages of these two options? What potential complications and side effects can either of them give me? I want to go into this as educated as possible. I have tried reading medical journals but want to hear from survivors and people in the trenches.
Cheryl,
I know my blog is really long to read, but you may want to check it out. My original surgeon did an unintentional Vagotomy somewhere along the way (of course I had no idea, and it has just been recently that my new surgeon has sorted it out). The vagus nerve controls many body functions in addition to the movement of the digestive system. From what I understand, intentional vagotomies are not common anymore for ulcers, especially anastomotic ulcers (which are typically traumatic ulcers vs peptic ulcers). I was on the verge of having a pyloroplasty done at some point (to speed up the emptying of the stomach), which from what I understand would have probably made me more sick, and I probably would have had dumping syndrome/symptoms each time I ate.
I'm not saying don't do it, just get at least one more, if not two more opinions from surgeons (don't forget about GI too), and from MAJOR medical centers (Cleveland Clinic, Mayo, Johns Hopkins, etc...No distance is too far for your health). In two years I have made about a dozen trips to Cleveland clinic, and it's 450 miles one way for me. I hope this helps, and get better :)
Jules
I know my blog is really long to read, but you may want to check it out. My original surgeon did an unintentional Vagotomy somewhere along the way (of course I had no idea, and it has just been recently that my new surgeon has sorted it out). The vagus nerve controls many body functions in addition to the movement of the digestive system. From what I understand, intentional vagotomies are not common anymore for ulcers, especially anastomotic ulcers (which are typically traumatic ulcers vs peptic ulcers). I was on the verge of having a pyloroplasty done at some point (to speed up the emptying of the stomach), which from what I understand would have probably made me more sick, and I probably would have had dumping syndrome/symptoms each time I ate.
I'm not saying don't do it, just get at least one more, if not two more opinions from surgeons (don't forget about GI too), and from MAJOR medical centers (Cleveland Clinic, Mayo, Johns Hopkins, etc...No distance is too far for your health). In two years I have made about a dozen trips to Cleveland clinic, and it's 450 miles one way for me. I hope this helps, and get better :)
Jules
Jules RNY 10/30/2007
this may be a stupid question with all your troubles but I know you suffer from sever gastroparesis from your vagus nerve problems - have you been on reglan or other meds like that? In 1998, I had surgery for acid reflux and my reflux was completely gone after that but about 3 months later it came back and I was nausous all the time like I never had before. My gastro doctor did some tests and said I had gastroparesis and put me on reglan and within a few weeks of adjusting the dose, the reflux was gone and so was the nausea - I also took zofran for the nausau. I couldn't believe. reglan was a miracle. I actually took it up until my RNY in 2008 and hten I stopped it. It didn't come back thankfully.
Just thought I would ask
Just thought I would ask
It is not a stupid question, and since the notifications are going to spam I didn't see your question until now. I have tried Reglan & Bentyl, and some other anti-spasmodics with no results, and the side effects can be bad enough to be on the 1-800 bad drug commercials that my doctors said that it's not worth the risk if I wasn't getting any relief from them. I wish they had worked!
Jules RNY 10/30/2007
Thanks Jules. Years ago when I started out in nursing they used to do vagotomys all the time for ulcers. You are correct that they don't anymore. My understanding is a selective vagotomy has quite a few less side effects than just a vagotomy. Was your selective or did he cut the entire nerve like they used to do. I will definitely read your blog. thanks so much for responding.
Cheryl,
As far as I know, he wasn't supposed to cut it. It's a long story. I've had test after test, trying to pinpoint the problem. It is especially tough, as you know being an RN, when you have some medical knowledge. It seems like it should be the opposite. Please keep me posted, and good luck!
Jules
As far as I know, he wasn't supposed to cut it. It's a long story. I've had test after test, trying to pinpoint the problem. It is especially tough, as you know being an RN, when you have some medical knowledge. It seems like it should be the opposite. Please keep me posted, and good luck!
Jules
Jules RNY 10/30/2007
I would be very careful before letting them cut that nerve - it can cause severe and I mean severe gastroparesis and along list of problems.
what treatments have you been on for the ulcers? How were you on for each one? were you tested for HPylori? IF it is HPylori - a bacteria and not treated with double antibiotics and a PPI=the ulcer will never heal - a biopsy is needed. did your surgeon do it or did you see a gastro specialist? I always have my endoscopies at a gastroenterologist. they do them all day long and know the proper testing and treatment protocols.
at this point, you should go to a major teaching hospital in a Major City= even if it means traveling - Mayoclinic, clevelandclinic, Columbia Presbyterian, Mt Sinai, Johns Hopkins, Duke, Etc.
what treatments have you been on for the ulcers? How were you on for each one? were you tested for HPylori? IF it is HPylori - a bacteria and not treated with double antibiotics and a PPI=the ulcer will never heal - a biopsy is needed. did your surgeon do it or did you see a gastro specialist? I always have my endoscopies at a gastroenterologist. they do them all day long and know the proper testing and treatment protocols.
at this point, you should go to a major teaching hospital in a Major City= even if it means traveling - Mayoclinic, clevelandclinic, Columbia Presbyterian, Mt Sinai, Johns Hopkins, Duke, Etc.
Most Active
Recent Topics
