Question about Surgery

OK guys.  Bldwshd's thread reminded me of something I've been wondering, but I didn't want to hijack his thread. I'm getting an RNY, so of course I'm going to have a lot of cut edges of my stomach - and more to the point, my intestine - exposed to God knows what in my gut.  If it takes 1-2 days for the things you eat to fully pass through the plumbing, and you only fast for 12 hours prior to surgery, doesn't that mean there will be partially-digested um... 'glop' in the intestine when she goes to cut it wide open? What stops the patient from getting massive blood infections and abdominal infections, from exposure to... well... "pre-feces", for want of a better word?  I'm not worried a LOT about it.  There has to be a good answer, or you would think every RNYers would be having a brush with death right after surgery. I guess since I'm an engineer, it would be nice to know some of the details of the mechanics.  Thanks. Boxman

From one engineer to another, for me it is all about proper planning providing the highest probability of success. Success being defined as a complication free procedure and quick recovery.  In other words, it is all about stacking the deck in your favor prior to surgery. The better shape you are in going under, the better your odds of coming out of surgery well. Therefore, the weight you lose, any muscle you gain, prior to surgery increases your probability of success. To use another "card" metaphor, the work you do prior to surgery pays off in spades. Follow the pre-op diet prescribed by your doctor and exercise as much as you can prior to surgery. Speaking of your doctor, I believe choosing your surgical team is as important as the decision to have surgery in the first place. When it comes to manipulation of the truth, there are lies, damn lies and then statistics. However, some statistics are hard to ignore. In my mind, performing Lap RNY is kind of like being a pilot. You are most likely to crash and burn during your first 100 hours of stick time. I believe the same to be true for surgeons. If you take a hard look at complication and mortality rates, just about all studies agree that the more experience your surgeon has, the better your odds of a successful surgery. Excellence, is nothing more then the mastery of acquired skills. This holds true for musicians, pro athletes, plumbers and even surgeons. Therefore, I put my money (life) in the hands of a very experienced successful surgeon. When you follow the pre-op guidelines and have the fortune to have a very skilled surgeon, Lap RNY has virtually the same complication / mortality rates as any other invasive surgery. Make no doubt, this is invasive surgery and there is the small possibility of tragic results even when everything is done right. In the end it is a roll of the dice. However, unlike Las Vegas, with RNY it is possible to give yourself significantly better odds on the toss. Just my experience, your mileage will vary. JP

I hear you JP.  When it comes to surgery, I don't want someone who's 'practicing' medicine, I want someone who's got the procedure down pat, ya know?  My surgeon will be Dr. Brenda Cacucci (same as Dan Packard below) and I have every confidence that she's 'got the procedure down pat' (over 850 lap. RNY's and counting).  Also, from my own meeting with her and others' testimonials, I feel I'm in good, experienced hands. Of course, as the day gets closer, I'm sure I'll have cold feet days, but that goes with the territory, right? 

Box, That’s why most docs have their patients do a “bowel prep” procedure.  Usually drinking Go-lytely or some version of Magnesium-Citrate solution along with additional prep of clear liquid diet for 2 days.  The Mag-Citrate “Rushes” the contents of the digestive tract right on out the exit.  Sort of like the “bouncers” of the Bowels. All of that is designed to minimize/ or at least greatly reduce the concentration of flora bacteria in the intestines. Along with this, standard gastrointestinal surgery protocol includes prophylactic antibiotics to catch/kill any stray bacteria roaming outside of the “pipes.” With most of the RNY’s performed, a surgical stapler is used, which seals the divisions off from any actual ‘opening’ as it cuts them free from one another.  Think of a staple gun with scissors cutting and simultaneously sealing a paper bag.  With most nowadays, the stapler is used to transect the pouch from the old remaining stomach.  The two cuts in the duodenum for the ‘bypass’ portion of the of the surgery are very small openings.  Typical saline irrigation in surgery alone can handle this.  Yes? So in answer, most WLS Pre-ops have a ‘bowel prep’ protocol from their doc, they greatly reduces the amount of “poo n the pipes” and even that “poo” is kept out of the rest of the body cavities by the surgical procedure itself. When digestive juices and bacteria gets out of it’s proper place- “a brush with death?” Yep!! All hell does break out!  (*see profile for details) Fortunately it is very rare, and survivable. Best wishes- Dx

 

Thanks, Dx.  That's the kind of thing I was wondering about.  I figured there MUST be some kind of pre-surgery 'power-flush'.  Also, I didn't realize that a surgical stapler cuts and staples at the same time.  If it also photcopied and faxed, it would make a great piece of office equipment! 

About the 'brush with death':  I DID read your profile before. You certainly had more than your share of complications, bud!  But you made it through, and that's the important part.   

 

Boxman -  We are all in this together - no thoughts of hijackeing anything.  I have had the same concerns also.  i think that the liquid diet helps to filter out most of the stuff.  i have a buddy who had it done and he took a laxative the day before because he heard that doing #2 is hard after.  Dont know.  I was not told to take anything laxative wise. Good luck

bldwshd,   Goodluck with your surgery tomorrow dude!  You'll be in my thoughts and prayers. Pastor BobM.

Hey Bldwshd, my thoughts and prayers are with ya bud.  You're going to have about a 2-month head start on me at the Loser's Side of Life!   

Boxman Being a minister and not an engineer I can not help you out very much on the mechanics of RNY. I believe you have one of the top surgeons around doing your surgery.  I did a lot of research before my surgery in Nov 05, and my selection was Dr Brenda Cacucci.  I went into surgery with total confidence in her being my surgeon.   Since I am also in Kokomo if you want to get together and talk, just send me a message and we can arrange a time and place to meet up.   Dan

Thanks Dan.  Maybe we can do that soon.  And yes, I think both my surgeon (Dr Cacucci) and the hospital (St Vincent's Carmel) are top-notch.  It's good to know that I'll be in experienced care.