Stricture, Endoscopy and stricture dialaton, Perferation

In had my surgery 9/24 for the first 4 weeks things went very well then starting October 24th things that were fine were not staying down. As of Sunday I could not even get liquids to stay down. I went into the hospital Monday they did an upper GI. Almost a complete blockage. The first small sip trickled through, the next two bigger gulps filled the pouch and esophogas. Then I puked. Yesterday I had an endoscopy and they dialated the stricture to 8.5mm and told me that I would have to come back and repeat in 3 weeks to dialate it again. Had some dry heaves on the way home, then fell asleep. When I awoke more wretching and heaving. Lots of tenderness. I called the DR and they told me to get to the ER. They found air under the diaphragm. So I have a perferation. They admitted me. Upper GI showed no leaks. Tomorrow if all goes wll they will start me on clear liquids.  Has anyone had similar experience? Any advice? Thanks, JDT

I'll give you what I've heard and read over the year concerning strictures.  10% of RNY patients get them.  A large percentage of those patients have to go back a second or third time for the endoscope.  Do not freak out if they want you back for a third time!!  Usually by the third time (don't quote me), about 95% of stricture patients get the problem resolved.  I don't know what they do for the other 5%.  It is a good question to ask your doctor.  Wishing you well.  Brian

I would post on the Main Board, should get alot of people in the same boat. 

CMUGirl (http://www.obesityhelp.com/member/cmugirl/) had similar problems. See her site for photos of her stricture. I think she had a tough time - in-home IV for several weeks because she couldn't keep anything down. She isn't on-line all that often. I hope you and the Doc get things taken care of soon. Joe Bear

Jon,  Went through the same thing you are experiencing. My opening closed down to 4 mm and I had a lot of trouble eating. Lots of puking, no fun at all is it? One wrong swollow and I would ralph for 45 min. Didn't ever seem quite fair, always puked out more than I ate. Liquids went down slowly for me but they did go down. Its due to the way we heal. Some of us scar more than most and that scarring creates strictures. I had to go back four times to get the opening dialated. The procedure, as you well know by now, is more of an inconvience that anything painful. At least after you have one under your belt so to speak. I fretted over the first one as I'm sure you did.  When I was having this trouble I posted but could not find anyone with a similar experience. Have no doubt about it, you did the right thing by having the surgery. If you have any more questions or just want to talk, let me know. Hang in there bud, it will get better.  Doug

Jon, At about the same time I to went to the ER after about 10 hrs. of RALPH, BUICK, and whatever else. More common early on. I was only dilated once, but was prepared to go more than once by surgeon. Good luck!!

Thanks for all of your responses.

One of the things that was really scary is that yesterday when the doc from the practice that did the scope came in she said that she was really surprised how small the opening was and that they had to use such a small baloon. Coupled with perf/air leak we would have to look at weather we should try to dialate again or whether the surgeon would want to do a revision.

The surgeon rolled his eyes and explained how complicated a revision is. That it is an open procedure.... It seemed to me that he thought she was an idiot for suggesting a revision rather than another dialation.

The prospect of a revision really bothers me. On Tuesday I found myself asking myself what I did to my self.

JDT

Hey Jon,

I tend to agree with your surgeons thoughts... A revision would be one of last resort to correct the problem. Dialations are the easiest method to stretch (enlarge) the stoma. I had it done twice just  about a year ago (3 weeks apart) and it corrected the problem.  My gastro said that it could take being dialated a number of times before the stricture is corrected but as long as they can get a baloon into the the opening then they can stretch it. Much better and easier than going through surgery again...   Most of the stricture postings I've read on the RNY board over the past year have been helped with 1 or 2 dialations though there have been some that have reported numerous proceedures before final relief. Hey strictures happens to about 10 percent of WLS patients, lucky us...  Don't knock yourself out about having the surgery this is just a temporary setback that will pass soon and don't wait to long before you schedule the second dialation, you should be able to tell based on your experiences when trouble begins keep an eye on it. Good luck, Art

Stay strong, Iasked myself over and over for a few days after 10 hours of puking, ER, diliation, but now it's only a memory!