Gastric Bypass vs Sleeve

Question
QUESTION: I have spoken with a bariatric surgeon who says he cannot guarantee I would get the surgery we decide on (i.e. gastric bypass) until the actual operation in case there is anything to prevent that procedure.  I have had a right hemicolectomy and another surgeon told me that that should not be a problem for gastric bypass.  What do you think?  How often does a surgeon go in to do one procedure and find that they can't?  Thank you.

ANSWER: Pam,
First of all, it is true that the prior colon surgery may have left behind some scar tissue that may interfere with the successful completion of the planned gastric bypass.  Having said that, R colon surgery *usually* does not cause enough scar tissue to seriously interfere with the gastric bypass and I might be a tad concerned about a surgeon who seems anxious to change to the sleeve.

Personally, I have discussed the possibility of a change with many patients but in practical reality have only needed to change to sleeve one time when gastric bypass was the originally planned operation.

You may want to ask your potential surgeon how many times (or, what percentage) of the time they have 'needed' to change from the planned operation to the backup procedure.  I would probably be concerned if the occurrence of changed plans is more than 10%.

Best of luck in your weight loss journey!

Dr JP

---------- FOLLOW-UP ----------

QUESTION: Dr. JP  - Would an xray or any other test/exam show scar tissue that might be problematic, before the operation?  Does scar tissue form quickly (my surgery was almost 9 months ago) or slowly? Thank you.

Answer
Pam,
It's a fair question that you ask.  Scar tissue (called "adhesions" by surgeons) forms in the first 2 weeks after surgery, and gradually softens after that but never goes away completely.  Some people form very dense adhesions, for other patients it is not so dense.  Unfortunately, there is not test that will tell your surgeon prior to operation what your scar tissue is like.  The best plan is for the doc to give him/herself a bit of extra time so there is no rush, and then deal with what is actually found at the time of surgery.

Best,
Dr JP

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