my doc wants to make scar tisue around my streched out

Question
does it make sense  for my doc to make scar tissue around my stretched out portal from a eight year old roux en y bypass before he endoscopically and orally re-staples my pouch? wouldn't it be better just to staple it all at the same time then have me travel out of state 4 extra times and go under anesthesia to have him make scar tissue 5cms at a time? My Anastomosis is 20cms he wants to  bring it down to eight by making scare tissue 5cms at a time 10 weeks apart.The object is to re-make my operation as i have stretched my pouch out and regained all my weight.Won't I have trouble with scar tissue around my new "esophagus" in the future?

Answer
Hi:

It sounds like your doctor is doing a procedure like Stompaphyx to try and help fix your Roux-en-Y.  To be honest, I haven't seen that great of results with Stompahyx among RNY patients.  Some people lose a bit of weight, but for many, it's an expensive waste of time.  I'd ask your surgeon to see published reports that this actually has been proven to work long-term for a RNY failure.  Because, honestly, I haven't seen anything out there that says this is anything but experimental.  Two better choices would be to consider a Lap-Band over your pouch or a true RNY revision either to a more distal RNY (more bypass) or a Duodenal Switch.  

The DS shows the best long-term results for revisions, but a Lap-Band may be a good choice if your weight gain has not been too extreme.

http://www.ncbi.nlm.nih.gov/pubmed/19263180?ordinalpos=2&itool=EntrezSystem2.PEn...
: Surg Obes Relat Dis. 2009 Jan-Feb;5(1):38-42. Epub 2008 Aug 22.Click here to read Links
   Adjustable gastric band placed around gastric bypass pouch as revision operation for failed gastric bypass.
   Chin PL, Ali M, Francis K, LePort PC.

   Smart Dimensions and Lite Dimensions Surgical Weight Loss, Fountain Valley, California, USA. [email protected]

   BACKGROUND: The failure rate after gastric bypass surgery for weight loss has been reported at 10-20%. To date, no reliably safe and effective salvage operation is available. This pilot study was conducted to determine whether restriction of the Roux-en-Y gastric bypass (RYGB) pouch using the adjustable gastric band (AGB) is an effective revision operation. METHODS: A prospectively accrued group of patients who underwent revisional surgery using the AGB placed around the RYGB pouch by our bariatric surgical group from October 2004 to October 2006 was analyzed. RESULTS: Of the 10 patients accrued during this period, 2 were lost to follow-up, leaving 8 patients for analysis. Of the 8 patients, 1 was a man and 7 were women. The mean prerevision weight was 135.75 kg (range 105-165), and the body mass index was 48.42 kg/m(2) (range 38.92-55). The mean weight loss at 1 year of follow-up was 17.03 kg (range 0.2-42), with a mean percentage of excess weight loss of 24.29% (range 0.2-49.2%). The mean weight loss of the 5 patients with 2 years of follow-up was 36.4 kg (range 20-58), with a mean percentage of excess weight loss of 48.7% (range 21.8-98.1%). One patient with 3 years of follow-up had a weight loss of 56 kg and a percentage of excess weight loss of 66.2%. Three minor complications developed: 2 AGB port-related complications requiring port revision and 1 postoperative wound hematoma requiring evacuation. No band erosions or band slippages occurred, and no major complications developed. CONCLUSION: In our study, an AGB placed around the RYGB pouch was a safe and effective revision operation for a failed RYGB operation.

Surg Obes Relat Dis. 2007 Nov-Dec;3(6):611-8. Epub 2007 Oct 23.Click here to read Links

   Comment in:
       Surg Obes Relat Dis. 2008 Mar-Apr;4(2):210; author reply 210-1.

   Laparoscopic conversion of failed gastric bypass to duodenal switch: technical considerations and preliminary outcomes.
   Parikh M, Pomp A, Gagner M.

   Laparoscopic and Bariatric Surgery, Department of Surgery, Joan and Sanford I. Weill College of Medicine of Cornell University, New York Presbyterian Hospital, New York, New York 10021, USA.

   BACKGROUND: Weight loss failure after Roux-en-Y gastric bypass (RYGB) is a challenging problem facing bariatric surgeons today. Conversion from RYGB to biliopancreatic diversion with duodenal switch (BPD-DS) might provide the most durable weight loss of all revision procedures currently available. Revision to BPD-DS can be done laparoscopically in 1 or 2 stages and involves 4 anastomoses: gastrogastrostomy, duodenoileostomy, ileoileostomy, and jejunojejunostomy (to reconnect the old Roux limb). This study reports on our early outcomes after laparoscopic conversion from RYGB to BPD-DS. METHODS: The data from all patients undergoing conversion from failed RYGB to BPD-DS were retrospectively reviewed. The data analyzed included age, body mass index, excess weight loss, method of gastrogastrostomy, and morbidity/mortality. RESULTS: Twelve patients were identified for analysis. The mean age and body mass index before conversion was 41 years and 41 kg/m(2), respectively. Of these 12 patients, 4 (33%) had undergone revision surgery (lengthening of the Roux limb, resizing the gastric pouch, adjustable band on pouch, or distal gastric bypass) before conversion; 8 (66%) had obesity-related co-morbidities; 7 (58%) underwent conversion to BPD-DS in 1 stage. Most gastrogastrostomies were performed using the 25-mm circular stapler. No patient died and no leaks developed. One patient required laparotomy, and 4 developed stricture at the gastrogastrostomy. The patients lost a dramatic amount of weight after conversion to BPD-DS, with a mean body mass index and excess weight loss of 31 kg/m(2) and 63%, respectively, at 11 months postoperatively. All co-morbidities resolved completely with the weight loss. CONCLUSION: Our preliminary results indicate that laparoscopic conversion to BPD-DS from failed RYGB is highly effective with an acceptable morbidity. Using a linear stapler to construct the gastrogastrostomy might reduce the stricture rate.

Hope this helps.  Whatever you decide, please seek out an experienced revision surgeon.  

Karla

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