Too Much Scar Tissue For Vsg?!

[gingersnap 11]

For those Band to VSG patients out there what did your surgeon's say about the increased risk of a leak due to scar tissue? Did they recommend RNY over VSG?

I met with the surgeon at MUSC yesterday that removed my band and he recommended that I have the RNY over the VSG because of the thickness of scar tissue in the area he would need to cut. With the RNY he can cut around the scar tissue but with the VSG he has to cut right through it posing a higher risk of a leak. He has done 3,500+ WLS's so I trust that he has the expertise. But I think he also doesn't want to see me gain any more weight while waiting around for Tricare to start covering the procedure.

Right now I'm looking into having VSG surgery at Fort Gordon which is 150 miles away. Leaks really scare me as I won't have health coverage right around the corner. I will have to travel to a Military Treatment Facility for any VSG care. With RNY my surgeon is just down the road!!!

[kdippy 36]

aawwww, good luck to you. I had the vertical, but my girlfriend had the rny, were both happy with what we have had. I think she lost weight faster, and easier with hers. I'm just saying.

[Ms skinniness 3,003]

This is very complicated. For this surgeon you would have to pay out of pocket? And he saids he can't do the sleeve because of scar tissue. Can you get a second opinion? With the RNY there is more of a chance of stretching your pouch and a lot of issues with malabsorbtion and nutrition deficits. Will tricare offer coverage for the sleeve? I really think you need a second opinion. This makes me uncomfortable.

A friend of mine who had RNY wasn't losing weight any faster than me, and was struggling with being able to go out into the community and eat certain types of foods w/o vomiting. Let us know what you decide.

[gingersnap 11]

My MUSC surgeon would do the VSG he just thinks the RNY is less of a risk for leaks due to the scar tissue. The real problem is that Tricare will not cover the VSG but a Military Treatment facility will. So I need to make the decision if the VSG is worth the risk of going to an MTF (Fort Gordon, 150 miles away) or suck it up and get the RNY at an established program with an expert surgeon.

I've asked my PCM for a referral for a 2nd opinion. But would love to hear from other Post VSG patients about what their doctor's told them and how their surgeries went.

[Wheetsin 714]

The scar tissue can be removed and/or cut back. I had over a pound of scar tissue removed during my procedure, and it took my surgeon about 2hrs compared to his normal 30 - 40 mins, but it's entirely doable.

3500+ WLS really doesn't mean squat if he is not an experienced revision surgeon. How may revisions has he done? How many band -> sleeve revisions has he done? Doing the procedure on a virgin stomach vs. a revision stomach is not the exactly the same procedure. I would find out how many band -> sleeve revisions he has done. That's really the important number if you want comfort in experience. I'm not trying to "knock" your surgeon, but I've never heard of the revision being impossible due to scar tissue. As my surgeon said, "I had to carve your sleeve out of scar tissue" (haha) "But you got a really pretty one." For a lot of surgeons it may come down to a balancing act between scar tissue and adhesions, and the size bougie or sleeve he's wanting. Do you know if he addressed your adhesions when your band was removed?

As for leak risk, it is pretty high (IIRC about 30% for overall "complication") when the removal & revision is done all at once. The more waiting time between the two, the more that risk goes down. My surgeon required 2 months between procedures, but do to an insurance fiasco it ended up being 6 months. I hate that, and love it, at the same time. The scar tissue can be mitigated.

As for my surgery, it went fine. I've had no complications (well, an allergic reaction to a medicine, but nothing specific to the sleeve), no nausea, no vomiting.

HTH

For those Band to VSG patients out there what did your surgeon's say about the increased risk of a leak due to scar tissue? Did they recommend RNY over VSG?

I met with the surgeon at MUSC yesterday that removed my band and he recommended that I have the RNY over the VSG because of the thickness of scar tissue in the area he would need to cut. With the RNY he can cut around the scar tissue but with the VSG he has to cut right through it posing a higher risk of a leak. He has done 3,500+ WLS's so I trust that he has the expertise. But I think he also doesn't want to see me gain any more weight while waiting around for Tricare to start covering the procedure.

Right now I'm looking into having VSG surgery at Fort Gordon which is 150 miles away. Leaks really scare me as I won't have health coverage right around the corner. I will have to travel to a Military Treatment Facility for any VSG care. With RNY my surgeon is just down the road!!!

[Wheetsin 714]

Which procedure do you want? It's my firm belief that the procedure, not convenience or coverage, should determine which people go with. I know people who wanted VSG but got RNY because it was all their insurance would cover, and I don't know a single one of them who says, "Boy, I'm glad this is what I got." If the procedure I really wanted meant I had to drive 150 miles, I'd drive it yesterday. I mean, that's only what, a bit over 2 hrs? (Guesstimating) I drive 2 hrs a day r/t to work.. no biggie, just bring good music and have a reliable driver once or twice.

[Ms skinniness 3,003]

My VSG went very well. I have had no complications with leaks or anything else. I did get dehydrated one time but that was my fault, not the VSG. I would choose this again in a heart beat. I also have lost my weight as quickly as a friend of mine who had RNY. I have/had less complications that she has. Love my sleeve.

[BlackBerryJuice 349]

It's a tough call and you can't compare yourself to others. 2 people will have the same procedure and end up with vastly different amounts of scarring. I'm assuming your surgeon has done some sort of imaging study if he's convinced your scarring is particularly bad? If so, I'd go with his recommendations.

One thing I've learned on my 3-week bariatric surgery rotation is that the leaks with RNY are, for some not yet known reason, easier to fix than with the sleeve.

[gingersnap 11]

Wheetsin....how many revisions has your surgeon done? I'm about 9 months out from band removal so my stomach should be healed well by now. I'm going to keep plugging away and get another opinion and also work on getting into the program at Fort Gordon...they have the fist info session in June.

Thanks for your input!

[Char 7]

I had two bands removed and had horrible scar tissue. My band surgeon said he'd never seen anyone build up scar tissue as much and as fast as I did. It took him a couple of hours to remove and replace my first band as opposed to the 45 minutes to put the first band in.

The only thing you'll want to do is make absolutely sure the MTF's surgical team knows you have been warned about your scarring issue. Try and convince them (it should be easy) that you'll need the surgeon with the highest successful number of VSG procedures to perform your surgery because of the scar tissue. I not only had significant internal scarring, I had a deformed upper stomach because of it and still had no problem with sleeve formation.

The only complication I experienced was a small bleeder (they missed or improperly sealed off a small blood vessel when they removed my lower stomach). It's a complication that can be experienced with any form of surgery and not specifically associated with bariatric surgery or my scarring issue. I had a 6-day stay in the hospital and a transfusion, but I was well cared for. They did not release me until they knew the internal bleeding had stopped. Just make sure the facility you choose has a good bariatric program that has been in place for a while.

[Wheetsin 714]

Sorry for the late response, I lost track of this thread.

Most of my surgeons revisions have been band -> RNY. I believe he has done about 1,300. Band -> sleeve was about 275. I'm not military so I didn't go through an MTF (just to clarify).

If there's an upside to lots of scar tissue (I had gobs of it)... it's the restriction. Scar tissue can play a role in how much "flex" (calling it stretch isn't really accurate) you have. The more virgin tissue, the more natural flex. The more adhesions/scarring, the less... just like how our skin can stretch, but our stretchmarks are scars and we aren't getting any more stretch out of that spot. I'm about 3 mos out and often still get full on tablespoon portions.

^ I actually had a good conversation with my surgeon about that yesterday. We're told not to graze, but if it weren't for grazing I'd max out at about 300 calories. I was talking to him about the verbiage he uses... if you tell people not to graze they're going to think in terms of meals. I have three meals, but 2 - 3 "snacks" -- but since each meal/snack takes at least 30 - 45 mins to eat (except for Protein bars, they go down like nothing)... that's about 5 - 6 hours of the day I spend eating, and in my book that sounds a lot like grazing.

Wheetsin....how many revisions has your surgeon done? I'm about 9 months out from band removal so my stomach should be healed well by now. I'm going to keep plugging away and get another opinion and also work on getting into the program at Fort Gordon...they have the fist info session in June.

Thanks for your input!

[Char 7]

I guess that explains why almost a year out from my surgery date, I still can't eat but a half or 3/4 of a small sandwich...even less if there's lots of meat on it. Cool beans!

[Ms skinniness 3,003]

Char, I really don't want to ever eat 3/4's of a sandwich again. That sounds like too much food for my tummy! I remember the doc at our orientation saying that it would take an hour to eat 1/2 a sandwich. i remember calculating that out to be 5 bites. They also said we can only take a bite every 10 minutes. However, I struggle with eating this slow, so I'm constantly working on this.

[Char 7]

If I'm eating 3/4th of a sandwich, it's usually egg salad or just Tomato on Whitewheat bread. Squishy food on regular-size, very soft bread with the crust cut off. It's something I treat myself with on occasion. It's kind of my new version of dessert. I generally stick to whole wheat and even then, I don't eat bread often. I can only eat half of a sandwich with meat when I actually make a real sandwich. Most times, it's just a piece of turkey or chicken lunch meat and some 2% cheese rolled up in a piece of lettuce.

When asked about food volume during our orientation, my surgeon told us that after a year or two, most bariatric patients can eat the equivalent of a McDonald's regular hamburger, the one you find in the kid's meals, more if they over eat and stretch out their pouches. Personally, I'm not into that kind of pain and I'd like to keep my tooth enamel, so I eat until I know my stomach is almost, but not full. It takes a while to figure out what that feels like. It's taken me as long as an hour and a half to eat a meal.

[AmberK1026 9]

My doctor did tell me that there is of course an increased risk of leak due to scar tissue. WE discussed VSG vs. RNY and ultimately I decided VSG was right for me because long term is safer than RNY. I didn't want to deal with malabsorbption or dumping syndrome. I had my band removed and revised to the sleeve in one procedure on May 29th. It took 2 hours longer than normal because of scar tissue but surgery went well and Im not having any problems.