Revision 5 yrs after RNY
I will be 5 yrs out this coming August. To date I have regained about 45 lbs. My hunger has increased and I can tolerate more than I have before.
Spoken to doc about doing "Plication of Gastrojejunostomy" (revision). Has anyone had this done with Dr. Meilahn @ Temple Hospital in Philadelphia?
Thx for any feedback.
Spoken to doc about doing "Plication of Gastrojejunostomy" (revision). Has anyone had this done with Dr. Meilahn @ Temple Hospital in Philadelphia?
Thx for any feedback.
I think that is some fancy name for "not an approved" bariatric surgery. Is it covered by insurance? I'd consider doing an RNY to RNY revision, RNY to Band or RNY to DS. What your talking about is Gastric Pilation, which is new, I don't think approved by the FDA and not even done that much. Why do something that has no history?
What were the results of your CT Scan and Endoscopy? Why are you gaining weight?
What were the results of your CT Scan and Endoscopy? Why are you gaining weight?
(deactivated member)
on 5/10/12 12:39 am - WA
on 5/10/12 12:39 am - WA
i found this on the web for you, as long as you know what your getting the choice is yours and no one elses. This proceedure as you said, has indeed been approved and practiced. I wonder if it is known on here as the Rose Proceedure or the Stomaphx?
Patients who have failed RYGB (especially after initial successful weight loss) are challenging. As the number of RYGB increase in the US, bariatric surgeons are likely to see this problem more frequently. Surgical treatment options include revision of the gastrojejunal anastomosis, placement of an adjustable gastric band on the pouch, conversion to distal gastric bypass, and conversion to duodenal switch.
Endoscopic therapies consist of either sclerotherapy or transoral endoscopic reduction. The goal of sclerotherapy of the gastrojejunostomy is to reduce the diameter of the gastrojejunostomy in a minimally invasive, low-risk manner. Specifically, submucosal and intramusuclar injections of five percent sodium morrhuate are placed circumferentially around the gastrojejunostomy to reduce the stomal diameter (by inducing tissue retraction and scarring). Data is limited regarding the efficacy of this technique. Spaulding reported a small series (n=20) of RYGB patients with weight gain who underwent sclerotherapy.18 Although sclerotherapy was 100-percent successful in diminishing the diameter of the gastrojejunostomy, the clinical effects were marginal: Seven to nine percent EWL overall, 25 percent regained weight, and only 45 percent noticed a “lasting difference." Catalano, et al., recently reported more favorable results with sclerotherapy in 28 RYGB patients with weight regain (>18Kg after initial successful weight loss) and a stoma size >12mm.[19] They injected 2 to 4mL of sclerosant (sodium morrhuate) per quadrant circumferentially. Success (defined as stoma size 75% of regained weight) was achieved in 64 percent of patients. Mean stoma diameter decreased from 17 to 12.7mm and average weight loss was 22.3Kg (ranging from 3Kg weight regain to 37Kg weight loss). Problems encountered included shallow ulcers at the anastomosis (in nearly one-third of patients), stomal stenosis (requiring dilation), and post-injection pain (in 75% of patients).
Patients who have failed RYGB (especially after initial successful weight loss) are challenging. As the number of RYGB increase in the US, bariatric surgeons are likely to see this problem more frequently. Surgical treatment options include revision of the gastrojejunal anastomosis, placement of an adjustable gastric band on the pouch, conversion to distal gastric bypass, and conversion to duodenal switch.
Endoscopic therapies consist of either sclerotherapy or transoral endoscopic reduction. The goal of sclerotherapy of the gastrojejunostomy is to reduce the diameter of the gastrojejunostomy in a minimally invasive, low-risk manner. Specifically, submucosal and intramusuclar injections of five percent sodium morrhuate are placed circumferentially around the gastrojejunostomy to reduce the stomal diameter (by inducing tissue retraction and scarring). Data is limited regarding the efficacy of this technique. Spaulding reported a small series (n=20) of RYGB patients with weight gain who underwent sclerotherapy.18 Although sclerotherapy was 100-percent successful in diminishing the diameter of the gastrojejunostomy, the clinical effects were marginal: Seven to nine percent EWL overall, 25 percent regained weight, and only 45 percent noticed a “lasting difference." Catalano, et al., recently reported more favorable results with sclerotherapy in 28 RYGB patients with weight regain (>18Kg after initial successful weight loss) and a stoma size >12mm.[19] They injected 2 to 4mL of sclerosant (sodium morrhuate) per quadrant circumferentially. Success (defined as stoma size 75% of regained weight) was achieved in 64 percent of patients. Mean stoma diameter decreased from 17 to 12.7mm and average weight loss was 22.3Kg (ranging from 3Kg weight regain to 37Kg weight loss). Problems encountered included shallow ulcers at the anastomosis (in nearly one-third of patients), stomal stenosis (requiring dilation), and post-injection pain (in 75% of patients).
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