Kim, I would assume that your surgeon is planning a "classic" Rny, either proximal or distal, and not an ERny. In general, I think that a distal is a better option for most people. That however is a decision for you and your surgeon who knows you better and has all the information. If the polyps are benign and also not adenomatous, then I wouldn't worry about the distal remnant. Once again, this is decision best made by you and your surgeon who has a complete picture. I am delighted that you have made so much progress in your quest for a revision and that your surgeon is working with you to achieve your goals! GOOD LUCK! Eric Schlesinger, MD, FACS

Deanne,
The hypoglycemia that you and others experience is the result of an overactive pancreas. It is continuing to churn out large amounts of insulin. When you were larger, your body was unable to react to insulin in a normal fashion. You needed very high insulin levels for your body to respond to the insulin and drive the glucose into your cells. As you get smaller, your body responds to lower levels of insulin. Unfortunately, your pancreas is slow in recognizing this. Most individuals will eventually have their pancreas "slow down". A few unfortunate souls will continue to be plagued by this problem for extended periods of time.
So, what can you do about it. The single most important thing you can do to minimize these wild swings in your blood sugar is to avoid high glycemic index carbohydrates. These type of carbs stimulate your pancreas to release a "ton" of insulin, which results in your blood sugar "bottoming out." Remember your "Golden Ratio", three bites of a high quality protein to every bite of low glycemic index carbohydrate. When your sugar gets low, correct it with low glycemic carbs, like an apple or pear. It will take longer to get your blood sugar up than hard candy or fruit juice, but it will mute the rebound hypoglycemia (low blood sugar).
The ERny may for a time accentuate the hypoglycemia. As you lose more weight and your body may become even more responsive to insulin. Just remember to eat some apple, pear, or other low glycemic index carbohydrate.
I hope that answers your question.

Eric Schlesinger, MD, FACS

Dawn,
Although I do not have a comprehensive picture of your intestinal anatomy, it appears that you effectively have an ERny. Your inabilty to gain weight is NOT your fault. Based on the information available, it would appear that you need to have the malabsorptive component of your surgery reduced, i.e. your common channel requires lengthening. This should be done ASAP if your nutritional status will safely allow the operative procedure. The best way for you to address your nutritional status is with an elemental diet. This is a special type of liquid diet that is most easily absorbed by your body. It is not the most tasty or appealing of drinks but as a way to gain some weight, it's your best bet.
I believe that your current condition requires urgent treatment. In other words, you don't need to head to the Emergency Room, but definitive treatment should be initiated SOON.
GOOD LUCK!

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

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

There are surgeons who would consider or attempt such a revision. I would advise against a laparoscopic revision. Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Hanna, The most important objective is to get you healthy. Lengthening your common channel would clearly improve your absorption. The question is: How much is enough? Unfortunately this question is impossible to answer. Your case is very complex and I cannot provide a simple answer. Based on what you have shared, I would give strong consideration revision to some form of a Rny. It would alleviate the acid component of your reflux. An upper GI that carefully measured the transit time of the contrast through your small intestine might provide some insight as to what kind of Rny would give you the best result (balancing correction of your defeciencies against weight regain). If you wanted to "play it safe" a very proximal Rny would offer you the greatest correction of your malabsorption. In all likelihood you would still require vitamin B12 replacement. It has the potential to improve your other vitamin, iron and calcium absorption as well. It should reduce the diarrhea, gas, odor, and bloating. Do not overlook the fact that with a Rny you would be at risk to "dump." Fastidious monitoring and follow-up would obviously still be required. If your malabsorption is well corrected, but you gain too much weight, by-passing more intestine at a later date could be considered. Please discuss these options thoroughly with your surgeon. NEVER GIVE UP! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Hanna, Are they planning to undo the switch portion of your DS? If your intestine is restored to its original state, you will likely have a significant weight regain. Giving you a small pouch will help off-set some of the regain, in part because there will still be some intestine by-passed. In order to make any kind of prediction, the exact nature of your revision is required. The planning of your revision is vital and something you must discuss thoroughly with your surgeon. How drastic a reversal you will have will depend on a number of factors. How severe are your vitamin and mineral deficiencies? Are you also suffering from protein malnutrition? Make certain that you understand precisely what operation is planned and why. It sounds like your surgeon has a lot of things to explain before you proceed. GOOD LUCK! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Hanna, In order to answer your questions in a public forum, I will make several assumptions. First, I will assume that you had an aggressive DS with a "common conduit" of approximately 50 cm. in length. Second assumption; you and your surgeon have been working together diligiently to correct your vitamin and mineral deficiencies. The two of you have at least discussed parenteral replacement (shots, IV's, etc.). Thirdly, that you have received extensive nutritional counseling and are stictly limiting your intake of carbs, avoiding fats, eating small meals so as not to "overwhelm" your system, etc. Lengthening your common channel will help improve your absorption of vitamins, minerals and nutrients. In so doing it will reduce your bloating, gas, and malodorous stools. It will NOT resolve these issues. You will still need to be vigorously compliant with your nutrtional program and fastidious about taking your supplements. The "sleeve" portion of your DS provides very little in the way of effective restriction. Just as pouches dilate, so too can sleeves. Any significant restriction requires a stomach component whose volume does not exceed 1 fluid ounce. It is impossible to predict how much of a weight regain you will experience. Much will depend on the exact nature of your revision. If your common channel is 100 cm or less in length, you will still have a highly malabsorptive tool. Your skin will adapt to the increase in weight. Appropriate skin care can diminish the risk of stretch marks. Let's think positively. If all goes well then no further WLS will be necessary. If you should require additional help, your DS can be revised to any ERny, thereby adding a significant restrictive component to your tool. GOOD LUCK! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Babs, Good luck with your revision! Clearly patients like yourself who suffered multiple problems with their Lap-Band would not be good candidates for another band. By my definition, regardless of how much weight was lost, someone with all of these medical problems is not successful. Perhaps it would have been more accurate to say "if you had done well with your band..." Thank you for helping to clarify this point.  Clearly there are people who are not well suited to undergo an adjustable gastric restrictive procedure. Those who suffer from esophageal dysmotility (the muscles of the food pipe do not function properly) are poor candidates for a Lap-Band. The incidence of esophageal motility problems is higher in individuals with Lower Esophageal Sphincter disorders. None the less, the vast majority of people being treated for GERD do not have an esophageal motility problem other than the weakened sphincter. It is an art to match each patient to the weight loss procedure that is best for him or her. This is just one more reason why selecting the "right" surgeon is so important.  Eric Schlesinger, MD, FACS AZ Weight Loss Solutions 

Nanette, Congratulations on your weight loss with ReSTORE!  If, after the upper GI, your surgeon recommended the Stomaphyx procedure, this would lead me to believe that  your pouch, stoma, or both still appear dilated. No NOS (Stomaphyx, ReSTORE, ROSE, EROS) is as yet covered by insurance.  All things are possible, but a 120 lbs. weight loss from NOS is more than anyone has reported. As far as your other options are concerned, either a "Band Over" procedure or an ERny should be discussed with your surgeon. You have been given mixed messages regarding your new degree of restriction. Your weight loss says something must be working after ReSTORE. Your surgeon's recommendation of Stomaphyx says that more restriction could be beneficial. If your most recent malabsorptive panel is good, a highly malabsorptive procedure (ERny) deserves serious consideration. Don't rush into anything. Before having any further surgery, wait. Let's find out how successful you will be with the ReSTORE procedure. CLAIM THE SUCCESS YOU DESERVE! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Kathi, Based on the information that you have provided, you would have all WLS options available to you. The decision as to which procedure would best enable you to meet your goals and desires is one that should be made by you and your surgeon. I do not have sufficient information to be able to give you a specific recommendation, but a highly malabsorptive priocedure deserves serious consideration.  All pouches should be constructed as "right sided". These pouches are less susceptible to dilitation (stretching) and are also more ammenable to NOS should "tightening" ever be indicated. GOOD LUCK! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions 

 

Ms. Cin,
The basic principles of wound healing indicate that the pleats or flaps should be healed in 4 to 6 weeks. When I complete a Stomaphyx procedure, there is no space in between the pleats or the rows of pleats for food to "get caught." None of my patients has ever had a problem with food being retained in between the pleats.

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions