Large stoma, small pouch, ?fix?

My surgeon is evaluating me for a revision surgery to fix my dilated stoma. The problems is that my pouch is so small that my options are limited. I had an UGI and now I'm going to have an endoscopy next week. He says my pouch would not have shrunk- so wouldn't it at least be the same size as when he made it 5 1/2 years ago? Has anyone heard of your pouch being too small to fix?

I am in the same situation for those of use with stoma issues they can fill it with cologen or in my case sense it is dialated so bad he is going to do a Lap over RNY and cologen fill he is doing a partial fill during my EGD on 04/07 My Dr is doing a clinical study starting in april that fills the stoma with cologen partway to help restrict the passage. We do have limited options Undoing the RNY completely and redoing it to a VSG is 1 option or to a DS depending if you need a malabsorbtion or a restrictive fix. I need restrictive so that is why mine is the lap over RNY w/ cologen fill. I am anemic and malabsorbtion is not an option for me. Good Luck.

I am a bariatric surgeon in Louisville, Ky and do a fairly heavy volume of laparoscopic revision surgery. When I try to recreate the anastamosis, aka stoma, which is the connect between the stomach and the intestine, I literally removed the old connection and staple the stomach closed just above the old stoma and then form a new stoma above where the old one was. So, if the pouch is very small, and you have to sacrifice part of the pouch to do what I am describing, you will end up with an even smaller pouch. You do want to reform the connection to stomach, and not the esophagus like you would if there were no pouch left. Other options include Stomaphyx, an endoscopic suturing technique or endoscopic injections. Or, I have placed gastric bands in this situation as well with pretty good results. I hope this answers your question. David Geller, MD Bariatric Surgeons of Kentuckiana

Thank you so much for your reply. I was evaluated for Stomaphyx and told that my pouch was too small. I am having an endoscopy on Tuesday to help determine if there is enough pouch to work with for a surgical revision. Have you ever stitched the stoma laparoscopically to make it smaller? I've read about the collagen injections- but do they last? I know people who have had collagen injections in their lips and face and it disappears over time. Thanks, Janelle

I am planning to get trained on Stomaphyx, but I have not done so yet. I am not familiar with the technical aspects of that procedure as to how the pouch is too small as you are describing. I don't know of a technique to stitch the stoma smaller laparoscopically. Usually I would recreate a new stoma, but that is only possible if the pouch is big enough. Most of the time, I find that both the stoma and the pouch could use some resizing. I would prefer to place an adjustable gastric band, either Lap-Band or Realize band, around what you are describing, because it would give control after surgery over the stoma size.  David Geller, MD Bariatric Surgeons of Kentuckiana

I was wonderfuing the typical or expected size of the stoma after 6 yars post RNY?  Mine was precisely measured at 1.76cm and my pouch was measured at 3cm by 5cm about 2 months ago?  Does this sound about average for my time frame?  I initially lost 255 pounds, but have gained back  around 95-100 pounds and am lookign at a possible revision, but dont know where to turn.  I have been really trying to be complaint, but I am constantly hungry and suffer from late dumping syndrome.  Need help and advise?  Thanks