Bypass Revision due to pouch opening being widely dilated?

[KarenLR75 515]

I had gastric bypass in July of 2019. Highest weight was 400 before losing a bit on my own. Current weight varies from 167 to 173. I still feel some restriction to this day. My meals are usually small although I know we can all 'eat around' the restriction by eating smaller, but continuous meals and this was a slippery slope I fought back against.

About 2 yrs ago, I started having right sided pain. It felt like the pain I used to feel when I ovulated so I assumed it was ovarian. Saw OB & had 2 ultrasounds and they couldn't even see right ovary (and the left was fine. Since they couldn't 'see' the right one, they said that was good since there was no obvious signs of..I don't know tumors, growths?

The pain continued to worsen & I finally had gall bladder taken out 1.5 yrs ago. I adjusted diet again to deal with gal bladder being gone and things seemed ok. A few months after that the right sided pain returned. About 4 mos ago, the pain got so bad at times I'd be in a ball on my bed considering going to ER (which I HATE doing).

Went back to primary got CT scan. CT came up with no findings. Then he referred me to GI doctor for colonoscopy & upper GI. I thought finally 'this was it, we've ruled out most other things'. I also had seen blood in my stools and it was old blood, like coffee grounds so I thought ok, not hemorrhoids?

Just got back home from colonoscopy & upper GI. I thought doing prep was bad yrs ago, but much harder having had bypass surgery. Good news is no polyps or other concerning things. Bad news is main finding was on bypass "Patient's surgical anastomosis noted to be widely dilated, raising possibility of Dumping Syndrome as a cause".

OK, most know what dumping is. I thought it was post surgery when we ate food (i.e. sugar, high fat) that processed too fast, etc. and you had dumping. Is the type of dumping they are alluding to different from our post surgery dumping? They recommended I see gastric bypass revision specialist. Has anyone else had revision NOT due to 1st bariatric surgery not being successful but for a "medical reason" like this (other than GERD, heartburn). I'm not even sure insurance will pay, but I have 2 yrs worth of history on this pain. Even it if does pay, I dread what this means for me - more Hair loss? If I do this, will I need another revision in 5 yrs again at which point I'll be getting up there in age. I also still feel restriction kick in although yes, nothing like 1st 2 years My highest right now hovers at 173. I hoped I'd get to 150 but closest I've come is 167-168. Is revision another 'nuclear detonation option'?

I've also wondered with the CT scan, etc. is there any chance of some straggler/stone from my gallbladder surgery 1.5 yrs ago that should be considered? Should I post this in the revision group instead? I read through some and was unsure. Are we allowed to cross-post? Any input would be appreciated. This is causing issues on my job as the pain hits out of nowhere (not X amount of time before OR after a meal, that I have been able to discern.

Thank you!

[WarrenInEC 14]

Yeah, my anastomosis was widely dilated as well. It was 54 mm.

Now it's 8 mm again.

[KarenLR75 515]

WarrenInEC,

I saw the bariatric revision surgeon. He doesn't think it is dumping and said that the upper and lower GI done would not have taken an image of the inside of my pouch so there could potentially be an internal hernia.

He suggested possible laparoscopic investigatory surgery in a couple of weeks. He said a revision to tighten the opening wouldn't necessarily force me to lose more weight, which is perplexing to me but I'm not looking at it as a solution to lose weight, I just thought that would come with the "package". I'm assuming the reason I still feel restriction when I eat is simply because of the 'pouch' then.

I thought I understood all of this 5 years ago when I had the surgery, but I obviously did not comprehend everything.

Well, we'll see what the next few weeks brings...

I assume you had a revision then as that is a big difference in the opening size..lol. If so, what was it like?

[WarrenInEC 14]

23 hours ago, KarenLR75 said:

I don't understand, physiologically, how you wouldn't lose weight if the restriction element is returned. Can you please elaborate?

WarrenInEC,

I saw the bariatric revision surgeon. He doesn't think it is dumping and said that the upper and lower GI done would not have taken an image of the inside of my pouch so there could potentially be an internal hernia.

He suggested possible laparoscopic investigatory surgery in a couple of weeks. He said a revision to tighten the opening wouldn't necessarily force me to lose more weight, which is perplexing to me but I'm not looking at it as a solution to lose weight, I just thought that would come with the "package". I'm assuming the reason I still feel restriction when I eat is simply because of the 'pouch' then.

I thought I understood all of this 5 years ago when I had the surgery, but I obviously did not comprehend everything.

Well, we'll see what the next few weeks brings...

I assume you had a revision then as that is a big difference in the opening size..lol. If so, what was it like?

[KarenLR75 515]

I'm not sure...surgeon just said that tightening that opening alone would not cause major weight loss. Unsure if during a full blown revision if they also reduce the size of the 'pouch' and tighten that opening. I would think 'pouch size' is a possible element as well but this doctor did not elaborate, I'm assuming since the goal of my revision if not to lose more weight maybe?

If I ever get time with him outside of the investigation in the OR, I will ask.

[WarrenInEC 14]

They reduced both my pouch size and the size of the opening during the revision. That's why I'm very puzzled by his comment that you wouldn't lose significant weight after the revision. It just makes no sense to me.

[KarenLR75 515]

Hey Warren,

I'm presuming because they would only look at fixing the opening if they did feel it was contributing to the pain and other issues I'm having 'downstream'. This would not be a true revision in the sense of reducing the size of the pouch.

My insurance company also only pays for 1 bariatric surgery in your 'lifetime'. They would only pass for the revision of opening if it were medically necessitated, and they would not consider 'failure to lose weight' or a 'weight regain' as medically necessary.

My GI wanted me to talk to the bariatric surgeon who specializes in revisions. The surgeon does not think what is happening to me is 'dumping due to widened opening'. He said it doesn't sound like dumping to him and if that happened to everyone whose opening widened, everyone would be having "dumping" issues after a couple of years.

He did point out that both the upper and lower GI I had done do not look at the inside of the pouch so if there is a hernia that is causing the on again/off again pain and on rare occasions bleeding (looks like coffee grounds), then the GI doctor would not know as they never 'scope' the pouch for a routine upper/lower GI. He also indicated that depending on the scope size a GI doctor uses, it doesn't go through every single space that we have (due to us having been um "modified"?) so it would take a doctor who uses an extra long scope. That last part I must confess I do not understand at all.

He does have me scheduled right now for a laparoscopic investigatory procedure to take a look inside my pouch and see if there is scar tissue or a hernia that needs to be addressed. He also gave me prescription acid reflux meds and said if i got better after 'taking' them, I could cancel the procedure in 2 weeks. What he fails to understand and I've tried telling his office, I can go a month with no pain. Then I go back to back days in extreme pain. Have not been able to tie it to specific food, time of day I'm eating, etc. My right side starts with a stabby/cramping pain (closest I can compare if it feels like the pain I used to get when I ovulated or that 'stitch in your side' type feeling. It often goes downhill from there. I have tried to get it figured out now for 2 years but taking ANY medicine and 'not having an episode in the next 2 weeks' does NOT give me a definitive answer as I do not have this pain all the time, it is just enough to be frustrating and has lasted LONG enough to be concerning.

The 'coffee ground' type bleeding that I have observed is one and off for the past 3 months (maybe it started a while ago but now I know what to 'look for'. I don't like going under anesthesia but I'm probably going to keep that procedure scheduled as I have no guarantee that ANY medicine given for the next 2 weeks has 'fixed' any issue.

I wonder if anyone else has ever had their opening revised but not their pouch out of curiosity.

[SleeveToBypass2023 2,598]

How are you doing now? Did you ever have the procedure done? How are you feeling?

[KarenLR75 515]

I'm actually scheduled for an exploratory peek into my pouch on June 6th so it should be interesting. If they don't find anything there, the bariatric surgeon said the traditional upper and lower GI do not go through every part of either our intestines or the bowel, cannot remember, but that he knew of 2 doctors in this area that had an 'extra long scope'.

Gah, I don't want that to be the NEXT thing we try considering I just went through the yucky 'prep' for a traditional upper and lower GI last month...lol.

I would think my 'new' GI doctor should have come up with some of this stuff and not just punted me to the bariatric surgeon and told that I may need a 'revision' as it sounded to him like 'dumping'. It has never felt like the dumping we experience after a bypass/sleeve. It has felt different from it this whole time. This GI doctor has decent reviews so maybe I will just follow up with him after exhausting the 'could it be related to my bypass' route he has sent me on and see if he has any other ideas of what it could be.

At this point, I'm getting kind of tired. My primary who is usually really good to work with told me 'you may just have to deal with ongoing, chronic pain'. He and I will talk about that 'not helpful at all' statement.

[WarrenInEC 14]

I'm doing fine. Down 30 lbs. since the procedure on May 4.

As Karen said above, the first step was an "exploratory peek" via an endoscopy to determine the size of the pouch and the diameter of the outlet (anastomosis). The doctor who did mine specializes in this type of procedure, so he wasn't a run of the mill gastroenterologist.

[KarenLR75 515]

On 5/30/2024 at 7:04 AM, WarrenInEC said:

I'm doing fine. Down 30 lbs. since the procedure on May 4.

Congrats on the loss, Warren!

Tomorrow is my scheduled 'peek'. Luckily the doctor doing this is a bariatric surgeon that specializes in revisions. Things at work and home are so stressful that I'm ALMOST looking forward to anesthesia simply for the temporary 'rest'...lol....

If there is nothing wrong 'there', then I'm going to have a long talk with my new 'GI' doctor.

I hope this doesn't sound bad but after chasing this pain for almost 2 years, I really want them to find 'something' and hopefully minor, but I'm running out of options and I'm still completely salty on my primary doctor's response.

[learn2cook 576]

How are you now? Was anything found or done? I’m concerned about the pain and the blood. I did have intermittent pain on one side like that and it was a small intestine hernia. Lying on my back felt more comfortable and I fasted from solid food while in pain. I only got an operation when it reached full blockage and was vomiting “coffee grounds.” I never had the “coffee grounds“ knowingly come out the backside. I’m still very concerned for you. I would ask for a blood test to rule out cancer.