Question:
very confused transected? VBG RNY???
This may be a dumb question, but just reading some questions in the past and today has brought around confussion. If someone (like myself) has LAP RNY, do I or do I not have to worry about staple line disruption??? Do I have staples that can burst?? I read about this and don't know if someone having this problem has had VGB or RNY. It is my understanding that RNY (Lap or Open) transects the stomach, stitched, then heals completely just like our old stomachs---solid. OR am I completely off-base. I quess my fear now, in reading all this GREAT info, is that my little baby stomach could burst! I know that this probably won't happen, but now I am questioning my knowledge on this subject. Please help clear the air -- I just want to be put to ease without having to call my surgeon. Thanks--Lisa — LisaL. (posted on March 24, 2004)
March 24, 2004
Well lets see. LAP vs Open is just a matter of access, it does NOT affect
your RNY. Its like cutting a BIG hole in a wall or drilling a small hole to
get inside. You may or not be transected, you will have to check with your
surgeon. Since so many staple line disruptions occur I think all WLS should
be transected, to avoid follow up surgeries.
— bob-haller
March 24, 2004
As far as I know I am not transected, I am not to worried about it though.
I don't think my surgeon has ever had a patient with a staple line
disruption. I would ask if you would like to know.
— Saxbyd
March 24, 2004
The staplegun used for most laparoscopic procedures actually cuts as it
creates its multiple staple lines (which seals both the pouch and the
remainder stomach). The typical staplegun used in open procedures does not
cut as it staples; therefore, there is a greater likelihood that you will
not be transected if you have an open procedure. This is not to say,
however, that surgeons who do open procedures can not transect the pouch
from the remainder stomach; some do.
The issue of the staple-line disruption comes about in a variety of ways.
First, for patients who are not transected, the weakest point of the
separation is on the sides; therefore, for non-transected patients who push
the limits of their pouch, it is possible that they can develop a channel
from the pouch to the remainder stomach as the over-abundance of food
consumed pushes the sides of the pouch and thus stretches it at its weakest
point, facilitating the entry of food into the remainder stomach. Because
most patients who have been operated on laparoscopically will have been
transected, this type of staple line disruption is less common among us.
However, as with everything else in life, mechanical stuff breaks down and
nothing is always perfect-- so care, particularly early on, is critical to
minimize the risk of staple line disruptions even among laparoscopic
patients.
— SteveColarossi
March 24, 2004
When I was having my surgery there had been a rash of leaks from the
staplers used for the anastamosis (connection) of the intestine to another.
I chose to have open the pouch was stapled off with four rows of staples
and then the edges were oversown to prevent leaks. Truth be told your baby
stomach can burst but the pain you'll experience prior to getting to that
point will keep that from happening-and you'll throw up. Which while
gross-it is exactly how surgery works.
— DrQ
March 24, 2004
Well, let's sort this all out. You're not a VBG ( vertical stapling with a
band) because you are RNY (gastric bypass). You probably ARE transected,
because of the equipment used, as Steve said. The device used to NOT
transect reminded me of a Veg-o-matic! LOL! The lap device is more like a
fat pen (but much longer). There's a difference between leak and staple
line disruption. My husband had a leak a few days post-op. He leaked at the
stoma (connection of intestine to pouch) and leaks generally occur right
away or not at all. A staple line disruption is a very different thing.
Since we were both done in the dark ages, being "just" stapled
& oversewn (we are RNY, too), the staple line (ours was 4 + sewn) is
like a wall separating two rooms and the SLD is like kicking a hole in the
wall. You don't die from it, but you can regain all your wt. My SLD at 5
yrs post-op. My husband is almost 9 and still intact, but everyone else in
our 1994-1995 support group has already SLD and been revised. So, what I'm
saying is that you are not SLD, and probably are transected, so cannot SLD.
The fact that you are so far post-op pretty much precludes the possibility
of leak. Steve already addressed fistula (froms a bridge between pouch and
old stomach) but those are really rare.
— vitalady
March 24, 2004
Just curious why you dont want to call your surgeon? No doubt the question
has come up before and a staff member will most likely answer it. Its my
belief posties are more successful when well informed but am curious to
your reason.
— bob-haller
March 24, 2004
Just wanted to correct something Steve said...SLD's do NOT usually occur
from people pushing the limits of their pouch. They occur because the
stomach tissue rejects the staples. If you think about it, the body is
doing what it's supposed to...rejecting a foreign object. That is a big
misconception that the patient somehow caused the SLD...don't believe it!
The total regains you hear of many years down the road is often a SLD, and
the patient is usually too ashamed to approach the surgeon, feeling they've
failed. The great majority of the time, it's a mechanical failure. And,
sadly, many surgeons still do not transect the first time around.
— Leslie F.
March 24, 2004
Thanks Leslie, for making that point! I mentioned on a post yesterday that
I refuse to take the blame for something that was totally beyond my
control. I was an open VBG and so my surgeon did my revision to RNY open, I
have a copy of his OR report and it states I was transected and bypassed at
150 cm.
— Ali M
March 24, 2004
Original Poster!! -- First of all, thanks for all the information! It's not
that I don't want to call my surgeon, I was just seeking information that
wasn't urgent. I guess I was just confused because my surgeon used staples
and stitches. Also after reviewing my pre-op literature last night-- he
does seperate the stomach into TWO portions. I guess I can be rest-assured
that I won't regain weight, due to SLD, because my stomach was not stapled
off (the "old" stomach stapling that so many had years ago.)
SOOOOO much information and sometimes it gets confusing. I just assumed
(yikes -- you know what happens when you do that)since most of recent
posties are RNY (open or lap) or LAP Band that I forget that some posters
had WLS years ago before RNY was popular. Soooo my take is SLD occurs when
the stomach has been stapled ONLY and the "old" stomach is still
attached, the staples are disrupted and now your stomach is basically back
to the size it was pre-op. Do I have this right?? OHHHHH the information
overload.
— LisaL.
March 25, 2004
Well, close, but technically, being RNY dosn't guarantee that you were
transected. But lap usually does. Many of us had RNY, but the stomach part
was stapled/sewn only. We still had the bypass, too. I was done in the dark
ages, so it was a bypass, but was not transected and I was open.
— vitalady
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