Enlarged Stoma - Related to EGD?

I'm pretty new to the revisions board so have been trying to get a grasp of the wealth of information here. I've been having a problem that was hoping that some of you would have insight to.

I had RNY 9/03. I lost pretty slow the entire time. I would say that I lost 80 lbs within 6-8 months, but then took another 1-2 yrs of just plain hard work to lose an add'l 80 lbs. I've been up and down the entire time with the same lbs, but recently I seem to be on a constant upward spiral. My lowest weight was 156 and today I'm at 180. Ever since my surgery, I've always had the pouch as a reminder that I needed to stop eating as I would get the pressure right under the breast bone.

Back at the end of March, I had an EGD looking for possible celiac disease. Nothing found there, but he told me that he removed several polyps at the stoma connection. Within a week or two, I noticed in passing that I was able to eat more, but didn't make the connection that it was a consistent pattern. Pretty soon though, I realized that it was at every single meal. I no longer feel that full/pressure feeling and my stomach feels like a bottomless pit. I can eat a full meal and never feel any sense of satiety. This is leaving me constantly in a state where I want to eat. It's like the food is never sitting in my stomach long enough to get any satisfaction.  When I contacted my WLS, the nurse told me that the EGD should have had absolutely nothing to do with this sudden change in my eating patterns. I find that very hard to believe as like procedures are used to intentionally enlarge the stoma opening to allow more food through. The doctor would not see me and instead wanted me to see the nutrionist. This left me thinking they believe it's just the normal feeling we all go through at some point, of "OMG, I've eaten myself out of the surgery/stretched my pouch, etc", even though I was quite clear to the nurse this was not the case. While I am nowhere near perfect with my eating habits, I know the sudden night/day difference in how my stomach reacts to food is not normal. While I feel no pressure where I have the entire time post-RNY, I've been getting nauseous and feeling a pressure lower in my abdomen. To further add to the misery, I've suffered from chronic constipation for the past 2.5 years and it has only gotten worse since this all started.  I met with the nutritionist and she said that while she sees many post-GB patients, none have reported such a sudden and dramatic increase/change in the way their body handles food. She gave me a new meal plan, which of course I will try, but can't help but feeling that an underlying problem has been created. At this point, I feel as if my entire RNY has been reversed (without my consent) and I was not prepared to deal with suddenly reverting back to the diet rollercoaster I had before WLS. If you made it through reading this long post (thanks), do you have any words of wisdom or input or can perhaps point me in the direction of additional information related to what I'm going through? I have already gone through the expense and recovery of 10 rounds of plastic surgery with one final scheduled later this year and therefore, this regain trend is absolutely terrifying me.

Kim

Kim,
In all likelihood, the polyps were an inflammatory reaction, possibly from healed marginal ulcers or perhaps from the suture material used to create your stoma. While biopsying them was medically necessary to exclude serious conditions, removing them (based on your symptoms thereafter) significantly enlarged your stoma thereby markedly reducing your restriction.
What next? This depends in no small way on your current anatomy and the details of your Rny. A thorough evaluation by a WLS with extensive experience in revisions will determine your options.
GOOD LUCK!
Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Dr Schlesinger, I had a gastric bypass in 1997. I am looking for a revison. My heighest weight was 420 and I now weight 342. I manage to keep weight off from the gastric bypass. I am a yo yo dieter. Lose weight and gain weight. I had 4 huge hernia's repaired  about 4 years ago. I had emergency surgery at Bosewll.  I know I have hernia's again because I have the same burning and twisting pain again. I have told that I have a maryter personality and wait till the last min. Some times I can't even eat like today because the pain is so bad.  I don't know if they are incarcerated yet but they were last time. If I have to have my hernia's repaired I want to have a revision to a DS or extension to my old gastric bpass. I have been told by many of your patients that you are the best when it comes to the revision. ( The Best in the West) My insurance will cover a revision. I asked my insurance company Healthnet Medicare HMO Ruby plan II and they said I could go to you. I don't know how long I can hold on with this pain it just keeps getting worse and worse. The doctor that did my original gastric bypass is now retired. I heard you take any revision's on from diffrent doctor's. I am going to call your office to see if I can get a appt on Monday AM. Could you please help me. Thanks, Dawn R Bacso

Dawn,
I believe that I can help you claim the success that you deserve. I look forward to seeing you soon!
Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

4 months after my RNY I developed a stricture. I required 3 sucessive dilations. My surgeon was out of town and a less experienced surgeon dilated me. On the last one I asked her not to dilate me because I felt I could eat and drink what I needed to. She dilated me anyway. After that day I was able to eat and drink more than I knew I should. I felt no restriction, never felt full. This doctor made me fell as if it were my fault because I over ate. Through testing (UGI and EGD) it was determined that I was in fact over dilated. As comforting as this was, I could not not find a doctor who would try to fix it. My original surgeon came back to town last year and 3 weeks ago he fixed me! I feel like a brand new RNY patient. THIS IS NOT YOUR FAULT! Don't give up on trying to get this fixed. Good luck, Janelle

Thanks for the replies. It's comforting to know this isn't all in my head.  When I read the pathology report, it had lots of language I didn't understand. I'll post below in the event someone here knows what this means:  [ANASTOMOTIC TISSUES INCLUDE SOME MILDLY CHRONICALLY INFLAMED SMALL INTESTINAL COMPONENT AND A GASTRIC COMPONENT WHICH HAS SOME FOVEOLAR HYPERPLASIA WITH FOCAL HYPERCELLULARITY AND LAYERING WHICH WAS INITIALLY A LITTLE WORRISOME FOR ADENOMATOUS CHANGE. HOWEVER, I BELIEVE THAT THIS IS STILL INFLAMMATORY REACTIVE "BRISK" FOVEOLAR HYPERPLASIA. THESE ALL AMOUNT TO ACTIVE CHRONIC INFLAMMATORY REACTIVE ANASTOMOTIC CHANGES.]  I didn't get the report until after meeting with my doctor and all he told me was that everything was fine. I'm one of those people who like to understand what's going on, so I need to have them decipher this for me.

Janelle, how did your surgeon correct this for you? I'm going to schedule a visit with my surgeon to discuss.  In the interim, I'm trying to go back to a liquid diet as once I eat the first solid food, the hunger starts. My goal is to work with protein shakes and other liquids for a while to see if I can help get this back under control until we know the mechanics of what has happened.

Thanks!

My surgeon went in laparoscopically and placed stiches around my stoma (4) to tighten it. It's been 3 weeks and so far so good! I am still on full liquids until tomorrow but I feel restriction. Good luck, Janelle