Question:
What is the risk of a Dilation Stretching the Stoma so that it cannot be repaired?

I am almost 5 weeks post op and feel like I have had surgery to make me bulemic. I had no problems at all my first 2 weeks, then my father died, and I vomitted/dry heaved for 16 hours continuously. I ended up in the hospital dehydrated. I have been very conservative on what I have eaten since then (shakes, tuna, pudding, cottage cheese, soup), but I'm still vomitting 2 out of 3 meals. Since it's not all the time, I don't know if it is a stricture or me judging the volume of the pouch incorrectly. My doctor says he will dilate next week if it's no better, but I'm afraid of the stoma stretching and completely undoing everything I've gone through for this. Has this happened to anyone? Anyone have any thoughts?    — Debra R. (posted on October 1, 2003)

October 1, 2003
I started having problems keeping anything down at about 2 months out. I was dialated 3 times. It kept closing up. I too was worried about them stretching it too much and destroying everything the surgery was suppose to do. However my gastric doctor talked to my gastroenteroligist and told him not to make the opening into the stomach larger than 10 cm. The first time he went in it had closed to the size of a pin, and he diated to 8, the following times it had closed to 3 or 4 and he dialated it to 10, but said it would probably close back to be an 8, which I was fine with. I haven't had to many problems since, but there for a while it seemed I could eat more than I thought I should and I was worried it was to big. Now I still have problems every now and then. I've heard it can still close up even several months later. I hope this helps. Jen
   — Jennifer C.

October 1, 2003
There is a range that they follow. When I had mine done, the tech stretched it to the top end of the range. I could have killed him. I think it was 15 something or another. Stuff went through way to easily after that, and does to this day, although they say it's an "acceptable" size. Hah! Just discuss your concerns w/ the tech, and tell them to stay on the lower end of the range, NOT the upper end.
   — mom2jtx3

October 1, 2003
It could well turn out that he will dilate you back open to what you were and not necessarily bigger. The stoma may have a partial stricture. He may also find that you have an ulceration and then he will give you some meds to settle that down and likely not touch the stoma. Express your concern to him but then let him use his professional judgement to do what is best for you. You trusted your life to him in the first place. They understand how important it is to be careful. Mine was dilated at about 3-1/2 months to about 16mm. At first I was very concerned as I did not assume he would dilate larger at all, just put it back to where it was. I had zero problems keeping food down for 6 weeks and then went through about 6-8 weeks of problems. They had to knock me out to open part of my incision again so also scoped me to see what was going on. He could not find anything so he decided to dilate a little. He assured me it would be okay and it has been. Yes the food typically doesn't sit for hours anymore and moves through in a reasonable amount of time, but not too fast. I definitely get full signals so the food is staying long enough for that. <p>You cannot keep going like this so let him do what needs to be done. Like I said it may be something totally different but easily fixable.
   — zoedogcbr

October 1, 2003
They have guidelines they they follow.They will usually dilate the opening a little bit over.So if your pouch size is supposed to be an 11 they may dilate you to a 12-16.They do this so you have some leeway because that area is going to be swollen and irritated after dilation, which in itself can promote the tissue to overgrow causing another stricture.I've had 5 dilations and my stoma has always shrunk back to the size my surgeon made it.
   — jennifer A.

October 1, 2003
I went through these same concerns and I would definitely get scoped if I were you. It's no big deal at all. For the first 2 months post-op I was vomitting 80% of what I took in, and people kept telling me to wait and see if my stoma relaxed and dilated on it's own. After questioning tons of people and calling several doctors to ask their opinion, I finally went and got scoped 3 weeks ago and it turns out my stoma had constricted to 3 mm (size of a pinhead). He dilated me to 15 mm, I was TOTALLY fine in my eating after that, and I went back in 2 weeks later for a follow-up visit to make sure I wasn't closing back up again. My stoma had indeed shrunk again to 5 or 6 mm, and he re-stretched it to 15 mm, the logic being that it will probably close up a little bit on its own again and I'll be in the 8 - 12 mm range. Even if it *doesn't* partially close back up, I'm not worried at all because I still get full quickly on about 2 -3 oz. of food, I'm still satisfied for a couple of hours, and I'm still losing weight. The ONLY difference is that I'm not pukin' my guts out 3 times a day.
   — Tiffany J.