Getting a revision; but is what happend to me normal?

I had a VSG in Feb. of 2012, initially i lost 150lbs and got down to 170. I've gained about 70lbs back. I attributed this weight gain my diet. Recently i decided that my continuing failed attempts to keep off the weight i.e. weigh****chers, ying-yang dieting were doing me more harm than good. I went to see two surgeons. The first told me i was a failure. When i had my preliminary appt with him he looked at me and said, if you gained that weight, whos to say you wont again" and told me to go about the procedure, continue to see the nutritionist, diet, exercise, psychiatrist.. and that we would "see". I cried that day, he made me feel like more of a failure than already do ( i am really hard on myself about this failure) I decided that i'd go see another, (better rated) doctor. I spoke to his officer staff and tech first, and answered a lot of questions, to why i failed, looking back it seemed like a test to see if my answers led them to believe that i would fail again. After the tech asked me questions, the doctor came in and asked me more questions about my original surgery. "when did i start gaining weight" "how hungry am i" "is it mental hungry" etc.. I explained to him that i was hungry from the minute after my surgery. The first two weeks of recovery were agonizing as i felt like i was starving, i was so HUNGRY. that my weight gain started as i began to eat normal foods, that my original doctor left me in the hospital covered in hives because he did not come and check up on me, and because i was taped up (i have a severe medical tape allergy) that his practice broke up, and diapered for about a year and that even though i didn't feel comfortable following up or going to see him again, i called his office about my weight gain and they told me that there was "nothing they could do". this new surgeon seemed very intrigued by my experiences and especially my hunger problem, he said he'd convert me to a bypass but first i need a endoscopy done to see what was going on, and the condition of my sleeve.

This  is what i am confused about:

The results of the endoscopy were that a "Stomach Pouch" has grown onto my sleeve and that, that is responsible for most my weight gain. When i originally went to the gastroenterology, he tried to tell me that i shouldn't get a revision. When he came to tell me the results of my endoscopy, he told me that a revision would be medically necessary and that it wan't my failure, but a medical failure. I can't for the life of me find any information about a pouch growing onto a sleeve of anyone else?! Am i the only one this has happened to!? Is this Normal!? I am meeting with the doctor again next week to set the surgery date. The gastro said My insurance has to cover the surgery because it is considered a complication and medical failure. But i just, for the life of me can't comprehend how this could happen.

I don't know the answer to your medical issues.  It seems like your sleeve worked initially and then it did not when you began to eat "normal foods" - but you lost 150lbs - what are the "normal foods" you speak of.  Certainly there may be something wrong with your sleeve - Ask what this "stomach pouch" diagnosis is with a qualified medical professional.

I just want to say that if you do not eat as a successful post-op should and exercise,  every weight loss surgery will fail.  The WLS will work in the beginning because physically you just can't eat a lot.  A bypass of sort may help you lose and keep off  the weight effortlessly  first year or so.  After that somewhat effortless ride early post-op, what do you you do when your surgery is not "doing it for you",  but when you must do the hard labor to work your surgery and keep the weight off.

Good luck to you.  You would be better off with the DS probably if you could abide by vitamin/ protein post-op rules.

Best,

L

Thanks!

I have read once or twice about similar situations, usually more often with RNY patients but I believe I read about VSG people having it occur too. It usually means the original doc messed up the surgery and didn't get a good suture line before he closed up! I agree with Zee that a DS would be the logical revision because you already have the sleeve. Of course that is up to you and a surgeon of course but it must feel good to finally know it wasn't you or at least you weren't totally at fault. Good luck to you!

It's nice to hear that I wasn't the only one this has happened to. The new surgeon doesn't think going to a DS would benefit me. I believe he said that there is no point to make me THAT mal absorbent and also, that there is the possibility I could loose "too much" But I'm going to discuss the options further with him, when I see him next week.

With a RNy, it is possible for a pouch to actually mend together with the blind stomach. They are in such close proximity. With a VSg, you don't have a pouch or a remnant stomach.  

I'd ask to see the pics from the endoscopy. What it sounds like to ME is that your Sleeve was done incorrectly in the first place. (We've seen a lot of trouble over the past few years with Sleeves that were incorrectly shaped, cut from the stretchier part of the stomach, etc. This could also account for your hunger---most of the 'hunger hormone', ghrelin, is produced in the fundus of the stomach, and you may still have most of yours---that could be the 'pouch' the endoscope is showing.

I most definitely would NOT go back to my original surgeon!

Before you convert to an RNY, have you explored the possibility of having your current Sleeve repaired, either with or without adding the intestinal portion for a complete Duodenal Switch? The DS has the very best long-term, maintained weight-loss stats, period.

If I could figure a way out of scanning my report I would be happy to show you! because I for sure have no idea what I'm  looking at! I am getting very concerned that it was in fact done incorrectly! Especially since I can't comprehend how this pouch formed or where it came from, and that the gastro said that it's medically necessary to get revision. I used to always say from day 1 post op, that I didn't think the surgeon cut out the part that makes the ghrelin, now I feel like it's all piecing together, that he really did maybe mess up, I've always been SO hungry. The "impressions" part of the sheet he gave me says " Enlarged Cardia/ Fundus s/p gastric sleeve" I'm not sure what it mean, but if what you say is true and the fundus is where ghrelin is produced that explains everything.

I will never go back to my original surgeon, and once what has occurred to me clears up, they will be receiving a very unhappy phone call from me. I'm very disappointed in his practice, and the former practice he was part of that also turned me away from any options or explanation as to my weight gain.

Originally, we had spoken about having the sleeve repaired, but he thought it was unnecessary at the time, being that we didn't know that my sleeve was something other than the shape it should had been. I'm going to discuss the DS with him over RNY next week when I see him. I think he just believes that the malabsorption might be a bigger issue with me and the DS over the RNY. I guess we'll find out next week!

It's nice to know that this "failure" was medical and not just caused by me. Especially since I work out and try so hard to stick to bariatric eating. I just couldn't control this weight gain, no matter what I did. I felt so personally at fault about it, it put me into a horrible depression, and I'm just learning it's not my fault.

Thanks for all this info and help! SO MUCH! :)

You should be able to go to the hospital where your endoscopy was done and get the images on a disc. Then you can mail that disc to other revision surgeons for second opinions. Showing them to ME probably wouldn't help. (*grin*) But yes, enlarged fundus is one of the problems I've seen people have when their original surgeon jumped onto the Sleeve bandwagon without adequate education/proctoring.

Oh, and I meant to add---there are surgeons who specialize in revisions who've had good success with repairing incorrectly cut Sleeves.