Question:
Why is a 9mm anastomosis not big enough?

Hi all. I've been searching the library & am very confused. I had lap RNY on 9/17 & had not been able to move past liquids. In fact, I vomit almost everything. I had an endoscopy on 10/7 -- my "pinhole" anastomosis was dilated to 9mm, but the doc told me that I'd need at least 1 more procedure. I thought that 9mm was pretty good (that's what the library entries suggest), but I am still vomiting everything ecxept Crystal Lite. I doubt that I'm getting 100 calories/day, and I'm sure that I'm not getting any protein. Even Isopure ZeroCarb comes up (just too rich?). Shouldn't I feel a little better? Shouldn't I be less dehydrated? Why must I wait 10-14 days for the 2nd procedure? Will I EVER get better? (By the way, I've only lost 14 pounds in 22 days!)    — Annie H. (posted on October 9, 2003)

October 9, 2003
Typically the first scope/dilation doesn't 'take' and it is very common to have to go back in for a 2nd procedure. A nine sounds very good to me, maybe he was just planning ahead knowing that it wouldn't stay a 9? And 2 weeks sounds like an awful long time to wait for another procedure. I would ask why such a long wait! Let them know that you are vomiting everything and even having a hard time with liquids. They should jump on that pretty quick! They don't want to be responsible for your dehydration. And your lack of calorie consumption has probably shut down your metabolism to near zero making you lose very little and make you feel awful. I hope you are taken care of soon.
   — Cheri M.

October 9, 2003
Hello to you- I am having similar concerns. I had surgery last Dec 23 and have been throwing up ever since. He told me in Aug that my anastomosis was a size 6 when he did the surgery. That is way too small in my opinion and I think things have gotten smaller since then. I finally have my doctor 200 miles away to do something so next week I am going for a gi and small intenstine study. Now mind you that I have had this since last Christmas. I dont know much about being dialated but am hoping for some relief from the agony. I did hear that sometimes the opening can close up again so maybe that is why your surgen is doing it again. Peace to you
   — Jencastle

October 9, 2003
Have you asked your Doc these questions? "only" 14# in 22 days, ??? thats more than 1/2 a pound a day. If you are expecting to lose faster than that you are in for a world of dissapointment. first worry about getting in what fluids you can. at 22 days I was still supposed to be on liquids as per the diet advancement plan given by my doctor. I could have full liquids, including milk, carnation instant breakfast, jello, broth, water, crystal lite, warm tea, no solids at all. I found warm liquids were easier to tolerate and felt better in my pouch. I truely beleive the slow approach to introducing solids was best for my healing pouch. please please please talk to your doc. they are being paid a whole lot of money for your surgery, let them earn it by bringing medical questions to them. you will get better if you listen to your doctor, keep up your fluids, even if only crystal lite.
   — **willow**

October 9, 2003
A 9 mm outlet is on the small side.I've had 5 strictures and dilations in 4 months...Doing a dilation can be a tricky thing...They are actually forcefully stretching the tissue which in itself causes swelling and irritation...which can encourage the stricture to reform.There is also the chance of having the staple line disrupt if they are too aggressive with the dilations.. That is why most GI docs will only partially dilate the stricture on the first visit. Then they will usually wait a couple of weeks to finish the dilation,giving the area some time for the irritation and swelling to decrease.GI docs will usually overdilate because they know that the tissue will retract back a little due to the inflammation caused.So even though my pouch is supposed to be an 11 he always dilates me to a 12.
   — jennifer A.

October 20, 2003
I had my open RNY on 3/19/03, after 6 months, I had the same problem. I had no idea about this. I'm told its a 1% chances of this happening, I'm sure this will increase with the increased number of people having this operation. My Anastomosis was at 1-2 mm. Boy I was really hurting, and very dehydrated. He dialated me to a 9, but warned me to stay on soft to liquid consistency. I did not listen and enjoyed the moment of eating anything I wanted. One thing I forgot that he told me as well was it was going to shrink and I would need to have it done two more times. He explained it me that it was like a rubber band, it stretches then shrinks a little, but if you keep stretching it, it stays. Most doctors like it at a 12 mm. So I will be going back this friday for my second scope. I can't wait cuz I can't keep anything down again.
   — E. C.