Lap band with an ostomy

[katandcharlie 0]

I am interested in visiting with someone who has an ostomy (ileostomy to be exact) and has had the lap band surgery. Have you had any problems? Set backs? Problems with your ostomy and absorption of nutrients? I have an ileostomy due to colo-rectal cancer and am starting the lap band journey. My surgeon has performed the lap band surgery on several ostomates, however, I would like to chat with an ostomate directly. Thanks in advance and good health to all.

[katandcharlie 0]

Thanks, Jack. I had to have my entire colon removed 4 1/2 years ago so I didn't want to staple off or in anyway do something that was permanent in case there were problems with the ostomy.

[jjsmiles 3]

Hi Kat,

I had an ileostomy almost 2 years ago (April 2006) and was banded on September 25, 2007. I did have a set back after surgery, due to my ileostomy, but looking back, I think I may have been chronically dehydrated due to my ileostomy for a long time.

After my surgery, I did not have any hunger and lost over 30 pounds between surgery and my follow-up Dr. appointment in 3 weeks. I knew that I was quite sick (incredibly weak and dizzy) and my ileostomy was producing incredible amounts (between 2 and 3 litres a day), but I hung on to see my surgeon (who also did my ileostomy). He ended up putting me in hospital and I ended up staying for 2 weeks. I was very sick, my blood tests revealed that I had really screwed up all of my electrolytes. Unfortunately I ended up gaining 57 pounds :eek: (no that isn't a typo) with all the iv fluids being poured into my body. I lost 25 pounds quite quickly, but the rest took almost 2 1/2 months.

No one can quite explain what happened to me, although the most reasonable explanation seems to be that because of the lap band surgery, my bowels got very confused and decided that everything I ate and drank had to be immediately ejected from my body. My ET nurse has said that your small intestine is a very greedy organ and that at any sign of trouble, it will take over and divert everything to itself, starving your other organs.

Happily, I haven't had any more complications since that time and my body has settled down. My production is down a great deal (I am eating a lot less now), but I haven't noticed any other difficulties. I take a Multivitamin and a Calcium supplement daily. I just had my blood work done last week and all was normal, except my Iron, which was low (first time ever), so now I started taking an Iron supplement as well.

[katandcharlie 0]

JJ, thank you so much for the info. I have been reading as much as I can get my hands on concerning the lap band/ileostomy situation. Both my oncologists, my ileo surgeon and my PCP have agreed that the lap band is the route for me and that if I pay attention to what I eat/drink I should not have any problems. They were also quick to inform me (rightfully so) that there is always the chance of complications when surgery comes into the picture.

If you compare your output pre-surgery to now I'm guessing that the amount has dropped, is that correct? I wear a smaller bag and empty approximatley 6-8 times daily. Before I have finished my dinner it is already processing through and in the pouch. With the lap-band does the food stay in your system a little longer? I would love to be able to sit and have a bite to eat and not have to jump up and run to the bathroom before the table is even cleared!

Pre-surgery (lab band), were you able to tolerate much Fiber? Salads, veggies, fruit? Post-surgery, (lab-band) are you now able to to eat those fiberous foods without a threat of a blockage? If it's not to personal may I ask what your average meal consist of now that you have the lab band with the ileostomy.

JJ, thank you so much for your post and I look forward to visiting with you. You clearly had a rough start but looks like you are doing great now! Thank you again and thank you for any more info you can share with me concerning the ileo/lap band.

Kat

[jjsmiles 3]

I was always a very high producer (hence my thoughts that I was chronically dehydrated for a long time). My normal days now are less than half of what they used to be - but be warned I have traded poop for gas:rolleyes:. It seems fine during the day, but once I lay down at night the air begins!!! I still get up usually twice a night to check and release. You will see other people post about burping a lot after a fill, my reaction seems to be night farts. My stoma has also shrunk by 1/4 " (I had a big stoma). I wonder if I should be counting that in my other measurements?:thumbup:

I have never had any problem eating fibre, and continue to eat as much as I can. I sometimes had problems in the past when I ate a large amount of vegetables, but since I eat so much less now, I can eat everything without issue. I still tend to produce right when I eat, that hasn't really changed since the surgery, although not with every meal (seems worse earlier in the day).

Most days I eat a package of low sugar oatmeal for Breakfast, for lunch a Protein (1/2 c. cottage cheese or 2 oz of low fat meat or cheese), a carbohydrate (maybe trisuit or Wasa wheat crackers, a piece of weight watchers whole wheat toast, or a low fat small homemade muffin) and if I have room a small yogurt or piece of fruit - I may have that for a snack later. For dinner I have 2-3 oz of Protein and vegetables (usually cooked as I like cooked veggies better). If I have a snack in the evening, I usually have a 100 calorie pack snack of something (popcorn is a favorite). My calorie count is usually around 1000 a day. I go to the gym 4-5 times a week, doing cardio every workout, plus strength training 3 times a week.

I have not been overly restricted up til now (just had my second fill last week - getting used to it but having no issues or pain) but I have managed my appetite very easily. I am in a strange position of actually having to plan to eat to make sure that I am getting enough nutritious food because I am not hungry. Yet just to be contradictory, pretty much every night, right after supper I want to continue eating, although I know I am full. My mind is a mystery to me!

I know this a long post - but when I look above, I will say that my lap band has not really changed my ileostomy and what happened before, still does, maybe just a little less (except for the gas).

One of the reasons I got the lap band is because I may have the opportunity to get my ileostomy reversed in the future, if I can have a successful bowel resection. That surgeon (different guy), refused to even look at me at my previous weight. I finally have an appointment to see him again on June 12, so hopefully I will now be able to proceed.

Although I had a rough start, I don't regret anything (ok I do regret gaining 57 pounds in 2 weeks :blushing:), and I would gladly get the lap band again. The surgery is a piece of cake compared to what you have gone through in the past, and if it is right for you, I would really encourage it. Oh by the way, the surgeon placed my port quite high (just below my ribs) on the opposite side of my ileostomy.

If there is anything I can do to assist, let me know!

Good luck.

[sharona 2]

I am a registered nurse and I think with an ileostomy it depends how much surgery you had and whether your prone to adhesions. Not sure this could be performed laparscopically. YOu need to have a heart to heart discussion with a reputable surgeon. Know the facts before you pursue. Also have you had chemo or radiation? that factors into your abiity to heal. Good luck my husband has had an ileostomy for 15 years related to Chron's disease..I hear your concerns.

sharon:)

[Kat817 19]

jj---I just want to say I love this site, and helpful people like you---you make it the great place it is, being kind and helpful.

Good luck with your possible reversal surgery--will send good thoughts your way!!!

Kat

[katandcharlie 0]

JJ, thank you so much for the information, your are a dear! Like you pre lap band, I am up 2-4 times during the night to empty and release air. I have grown so use to my night time bathroom trips that I don't see the additional air/less output as a problem, it may even be a blessing as my ostomy supplier is now carrying pouches with an air vent specifically used by those with an ileostomy.

Yes indeed, include that stoma srinkage in your measurments! A question concerning your stoma if you don't mind... I have the "apron tummy" and my stoma is about 3-4 inches below and right of my belly button. As the weight goes have you found your skin sagging around the stoma? Is it difficult to get a good fit with your flange due to the excess skin around the stoma area?

Oh my, doll, you are soooo fortunate that you have been able to tolerate Fiber with the ostomy! I would LOVE to sit and have a bowl of popcorn or a big, juicey orange, but noooo, too much fiber for me! With the lap band I will not consume as much food so in my mind I'm thinking that I may then be able to tolerate fiber in small amounts and not have to worry about a blockage. Thank you for the info on your basic daily food intake, that is a great help to me!

My very best wishes on getting your ostomy reversed! Because of the cancer and sever UC I had to have my entire colon and rectum removed. About 6 months after my ostomy surgery I checked out the internal pouch surgery and the exact words of my surgeon (real sweetheart, let me tell ya!): "Oh, Katherine, you're too fat for that, get real." :thumbup: I wanted to rip his large intestine out and swing him around the room by it! You are in my prayers and who knows, by this time next year you may have a sucessful reversal!:tt2:

Thank you again, JJ, you have been a great help and full of information!

p.s.... I had a port when I was going through chemo and I was AWAKE when they put it in and then removed it! It will be nice to be knocked out for the lap band surgery!:tongue:

Kat

[katandcharlie 0]

Sharon, thank you for the info. Yep, I am having a VERY heart to heart with a very reputable surgeon. I didn't conquer two go arounds of cancer by not knowing information, information, information and more information is a must! I have had numerous lengthy discussions with my radiation oncologist and my chemo oncologist and they both agree that I should pursue the lap band surgery. They were also very quick to point out that they are NOT weight loss surgery experts and that it was a must for me to go with a reputable surgeon who has expereince with ileostomy patients. My thoughts are with your husband.... Chrons is a terrible disease and so hard to control. I suffered from c-diff, UC and then colo-rectal cancer. Seems my colon just didn't want to hang around for the rest of my life, it wanted to spend its time in a glass jar filled with preservatives!

Again, thank you so much! It's wonderful that someone in the medical field is on this sight and not afraid to offer a little moral support and common sense advise! Bless you!!

Kat

[jjsmiles 3]

Kat 817- thanks for your kind words. You have been very generous with your support to many people on this forum and I always enjoy reading your posts.

Other Kat - wow you have been through a huge ordeal! I hope you are all clear of the cancer now. The lap band and port are REALLY easy in comparison.

I hear you about Dr's though. My ileo/lap band surgeon has been so supportive, while the bowel guy has been a complete jerk. When I saw him a year ago, he point blank told me not to bother coming back until I had lost at least 100 pounds. When I attempted to make an appointment last week, he declined to see me, until I created a big stink about him sticking to his word as I have lost almost 100 pounds. I hope to be around 200 when I see him in June and hopefully his attitude will have changed a bit. Unfortunately there aren't too many dr.s in his specialty and I can't stand the thought of waiting another year to see someone else.

I am probably not the best person to get advice on pouch adhesion as I have extreme difficulties in that area. I have a huge peristomal hernia and wounds around my stoma that have not healed in 1 1/2 years (not that jerk surgeon above cares about that :thumbup:). I have not been able to have a pouch adhere for more that 24 hours in many months (last month was a total nightmare where I used 45 pouches in 29 days). I need to have a bowel resection before I can have my ileostomy reversed and the hernia fixed, so no relief for 2 more surgeries.

I think you need to be prepared that as you lose weight and your body shape changes, flange adhesion may be impacted. I haven't noticed sagging skin to be an issue (not because I don't have sagging skin because my sagging skin is like the 8th nightmare of the world), but if the area around your stoma starts to dimple or dip, that is another story.

I have had a number of surgeries, although only 2 laproscopically (ileo and lap band). The surgeon did not have any problems doing the lap band laproscopically with me. He did the main, mid line incision horizontally beside the vertical incision of the ileostomy incision. Hmmm - between the sagging skin and the frankenstein surgery scars all over my body, I am thinking I should be promoted to the 7th nightmare of the world :thumbup:.

Best wishes!

[katandcharlie 0]

JJ, perhaps your bowel surgeon and my ostomy surgeon went to the same school of no-bedside-manners! :thumbup: Good for you for making a stink! When my health took a turn for the worse 6 years ago I decided that the only one who could really "save" me was me, myself. I read, asked questions, read more, asked 200 more questions and then read some more so I would know exactly what my options where and how to get my health back. Amazingly I am a healthy person just extremely overweight and I battled cancer. But I'm not blind, I know that I have got to get this weight off or my health will fail me and there will be no recovery.

I have been extremely careful with what I lift and how I push or pull things. My big fear was causing one of those nasty peristomal hernias. I know that if I don't do something about my weight that it will just be a matter of time before I have a hernia the size of Rhode Island!

Oh my, I am so sorry you don't get better wear with your flange. I count my blessings as I normally can go from 4-6 days with the same flange. I use a two piece system with an Eakin seal to add a little conformaty to the flange. My stoma is very short and approx 1 1/2 diameter. Without the additional seal my stoma is so flush to my tummy that waste runs under the flange (does expel away from my body with "umph") and that causes all kinds of burns to the area around my stoma.

The dr's were not able to do my ileo laproscopically because of the cancer so my tummy probably looks a lot like yours (road map city!) I know that there are challenges with having the ostomy and pursuing the lap band but I believe being armed with as much info as possible and maintaining a positive yet realistic attitude is very much in my favor.

Thank you again for the info and be well!