Question:
Staple Line Eruption?? Why & How to Correct

2 yr po open RNY needs info on causes of Staple Line Eruption and how it's repaired. I started out having continued esophageal spasms, dry heaves, nausea, right sided upper abdominal pain, with 20 lb weight gain all within the last 3 months or so. I have no idea how this may have happened to me, what my opions would be for repair if any at all, and if BC/BS PPO would cover this kind of repair. I'm so devastated and confused, any help/comments would be greatly appreciated. Thank You    — Barbara M. (posted on November 10, 2003)

November 10, 2003
Barbara, I have seen this discussed at http://groups.yahoo.com/group/DS_Revision/ - I haven't experienced it myself, though. Maybe someone at this Yahoo group will be able to offer you some knowledgeable advice! Blessings, dina
   — Dina McBride

November 10, 2003
You need to immediately see your surgeon (or your local emergency department) to determine the exact cause of your problem (an ultrasound or MRI would probably show if the staple line is broken). Then, assuming that you were not transected, your staple line eruption could have been caused by just a mechanical glitch in a few of the staples (it happens sometimes) or by pushing the limits of your pouch a little too often (the risk of a staple line break is greater if you are merely divided and not transected). Secondly, insurance should cover the repair as it is critical to your health (particularly given the extent of your side effects). Lastly, but also very importantly, is to try to understand why you think you've been gaining weight when you've been suffering from nausea for a few months-- the answer to that question might help you in trying to understand your staple line broke down (if it did). Don't hesitate to get this checked-- you've put in two long years in getting healthy and deserve the second chance that having the staple line fixed will give you.
   — SteveColarossi

November 10, 2003
Hi, I am 2 yrs post op from my revision to transection after disrupting at about 9 mos post op. It was devastating and I know just how you feel BUT you must realize this is not your fault! I am assuming you were not transected and this is a mechanical failure of that. The staple line does not form a good tight seal with scar tissue when you are just stapled no matter how many rows you have. I had 8 rows. The staples just come loose and then the food flows over the pouch into the old still attached stomach. I did have BC/BS Fed program and they denied my revision at first because they said it wasn't medically necessary to fix it! Bah Humbug~ They are crazy. I had a secondary insurance of AETNA and so rather than waiting to fight BC/BS I just went to the secondary. It paid everything. I think if I had shown medical necessity to BC/BS they would have covered it. I was lucky in that I was able to get mine repaired quickly and didn't gain any weight. But I would have gained it all back if I hadn't had the pouch transected. Transected means physically separated by cutting and then stapling and then oversewing the line. The little pouch is apart from the old stomach. It is no longer connected. This assures you that you won't have staple line disruption. Staple lines can disrupt (if not transected) at any time....6, 7 years down the road even. Please don't feel despair because you can have this fixed and the second surgery (although it will have to be open too) is a lot easier because if you are like me, your bypass is still intact. I understand exactly how you must feel. I was almost suicidal when this happened to me but luckily, Michelle Curran and Shelley helped me to understand that it was not my fault. You cannot OUTEAT your pouch. I hate it when people (who do not know what they are talking about) state that "so and so just ate so much her pouch disrupted". NO WAY ! If a person would do this it would take many months of constant overeating and stuffing and pain!!! I advise you to have an upper GI done immediately in order to determine what needs to be done. I hope your surgeon will transect this time. Find one who will. Oh, and one more thing: This is considered corrective surgery and most insurances should cover it. If BC/BS gives you trouble, just don't give up and bug them to death. I had a hospital administrator advise me just last week to keep bugging them and bugging them and bugging them. I am trying to get approval for a TT and hernia repair. Never give up your dreams! I lost 68 lbs before my SLD and now I have lost a total of 120 lbs. And there is one more thing to look forward to: Another honeymoon period when you lose quickly. God bless you. If I can be of further help, just ask. My profiles tell my story in detail.
   — Mylou52

November 10, 2003
Yeah, what Marilyn said. My SLD at 5 yrs. I see LOTS of us kind so knew immediately when I had a pouch full of acid that it was not My Turn. But since I kinda expected it, no time wasted on guilt or anything. JUST FIX IT. My ins company said, "Oh? A repair? I dont' see why not." and presto, it was done. While I was waiting for the letter to be written at the doc's (don't ask--lol), I had plenty of time to pre-load protein, beef up for surgery. Except for hurting a lil there and needing naps, my revision was absolutely a "non-event". I lost the coupla lbs I'd gained and was the same as before revision. Except now I can often chicken & rice and couldn't before. Go figure. There IS no fault or blame with mechanical failure. May as well beat yourself up for a flat tire or a snow storm.
   — vitalady

November 11, 2003
Not to sidetrack Barbara's concerns, but not all staple line disruptions are purely mechanical glitches. It is possible (and I have seen at least two occurences)where patients (particularly those who are not transected) can eat through their surgery, given that the staple line is not absolutely impervious. The fact that the poster chronicled a 20 pound weight gain (while experiencing intense nausea) and a staple line disruption does give rise to the possiblity that consumption may have been a factor. We all make mistakes in dealing with food after surgery, and unfortunately, for some of us, the cost of those mistakes is more than just getting sick for a few hours or gaining a couple of pounds. However, nothing should detract from the pain and the uncertainty that Barbara is enduring and the need to seek immediate medical treatment and to then move forward.
   — SteveColarossi

November 12, 2003
Hi Steve, please advise where you received your information that one can have SLD by overeating? I don't see how it is possible because the pain would be horrible! When one is not transected, the chance of disruption is alwsys there because the body rejects foreign objects in some patients. With SLD a patient feels bad enough without having the blame put on him/her. We failed all our lives and now to fail at our last chance? No, this is not the reason people disrupt. I am sorry but I just don't see how it is possible to bust out of your pouch by overeating. Any surgeon who does not transect these days is putting his patients at a risk of disruption and the assurance that transection can prevent this is something all surgeons should consider. I don't see why respectable surgeon would not transect. Aside from this controversy, I would never place the blame on the patient. Would one blame a person who has diabetes when they lose their sight? I don't think so. Good luck Barbara. I see where your SLD has been confirmed. Don't waste your time or energy on blame. Just get it fixed as soon as possible and all will be ok. This time make sure you are transected. Been there/done that and I understand.
   — Mylou52