Question:
transected pouch or non-transection--is one better than the other??

I saw my surgeon for a preop consultation and he told me that now he transects the stomach and separates it from the pouch. He is planning about an 80cm bypass--I am 245lbs and am 5'6", with numerous health issues. My question is do you stand a better chance of success if your transected, non-transected or what?? The transected part concerns me a little because it would seem a little easier to get a leak. My surgery is Monday, any answers would be greatly appreciated--what did you have done and how are you feeling??? Thanks:)    — Grace K. (posted on May 31, 2002)

May 31, 2002
I had non-transected the FIRST time, then transected with the revision. If I had a choice, it'd been transected the first time. The risk of leak, as in life thretening leak is done withing a few days. The risk of stapleline disruption hangs over your head, day in, day out, until the day it finally disrupts. I watched all those done around the same time I was as their SLD and mine didn't, but I knew it was a matter of time. 5 yrs. to be exact. I was lucky I had the right insurance to fix it.
   — vitalady

May 31, 2002
Boy, do I agree with Michelle on this one! Definitely go for the transected. I, too, had a SLD...found out after less than 6 months when I stopped losing. No pain, no other symptoms other than being able to eat a lot. Some just blame the weight regain on themselves for years & years and never check to see if it's a mechanical problem. I had a lap transection a year after my original open RNY. But why put yourself through a second surgery if you don't have to? JMHO
   — Leslie F.

May 31, 2002
Transection of the stomach is considered to be the "gold standard" in today's RNY surgeries. It prevents the possibility of staple line disruption and leaks. However, it is a technically more difficult surgical technique than merely stapling the stomach wall and requires more expertise on the part of the surgeon. I have a transected pouch, am 27 months post-op, and have had absolutely no problems. Good luck!
   — Diana T.

May 31, 2002
I do not have a transected pouch..while I am very happy about everything now...I do sometimes wonder "Do I have a SLD".When I feel that I ate more than I should have. If I had been transected I would never worry, and considering I had to fight my Insurance tooth and nail to get approved I fear that I will get a SLD and not get approved for a revision. But, honestly at the time of surgery I still would not have got a transected pouch, I feared that this would not work for me(like everything else I tried) and If it was transected, they could not fix it back...I realize now that was a silly thought..this is not 20 years ago when they stapled you and gave no real follow-up or guidelines. My doctor does not transect anyway and I was very comfortable with him. It really is a personal decision, like the surgery itself..just take all the facts and make the decision that is right for you.. Best wishes, Tricia
   — Patricia R.

June 1, 2002
Definitely transection. I had a disruption of my nontransected pouch staple line at 6 mos post op and had to have another surgery to be transected. It is a personal choice but the options are: 1. Transection and after a few days of healing = permanent rny OR 2. Nontransection without as great a chance of a leak in the first few days = the chance of a disruption someday in the future and regain of weight OR 3. Nontransection with a lot of luck = no disruption in your lifetime. I asked my surgeon why he has begun transection now as opposed to nontransection. He said the success rate is higher with transection and then he commented to a resident with him "it is a lot easier to do the surgery with the transection also! So everybody wins!" I think most of us would choice one surgery over having to have another surgery later. I was fortunate in that I had the two surgeries in one year and carried the same insurance...Aetna. Luckily, they covered both the original rny and the revision to transection. Some insurances wouldn't. I had BCBS Federal as my primary and they denied it. Said it wasn't medically necessary. Thank goodness Aetna didn't see it that way and picked up as the secondary insurance. All together both surgeries cost approx $50,000. In my opinion, transection is the way to go.
   — Marilyn C.

June 4, 2002
I have heard too many horror stories of people with staple line disruptions, who regain their weight and are back in the same boat as they were before. With a transection, there is no chance of a staple disruption. The stomach is actually cut completely in two, and then heals to form a permanant pouch. Yes there is a slight chance of a leak, but that is much smaller than the chance of a disruption and undoing your surgery.
   — Dell H.