I'd like to share my experience after 2 weeks of gastric plication

[NotSoLittleMermaid 14]

Thanks KB, I am planning my surgery soon, and will take your advice the 3 day stay. I was wondering about how long to stay after surgery. Great advice about the whole process!

[DrWatkins 13]

Regarding acid reflux, this is most commonly caused by a hiatal hernia.

Hiatal hernia is when the opening in the diaphragm (breathing muscle) for the esophagus (swallowing tube) is too big. Being overweight contributes to hiatal hernias because of chronically elevated intra-abdominal pressure.

One thing I have learned after doing weight loss surgery exclusively for 8+ years in thousands of patients is that every overweight patient has a hiatal hernia and this must be addressed to minimize problems with weight loss surgery. At best we find the hiatus dilated and needing to be strengthened with suture.

Many surgeons don't address this at the time of the weight loss operation and this causes a lot of problems down the road.

What I have learned is that you have to look for the hiatal hernia - it is not obvious. What I mean by that is that you have to dissect out the diaphragmatic crura at the time of surgery. (The crura are muscular pillars around the esophagus). This opening is supposed to be about the size of a quarter (coin). We frequently find it the size of a small lemon and they can get really big, sometimes nearly the size of a baseball. Hiatal hernias are simple to repair by stitching the defect down to the proper size.

The other issue to prevent acid reflux is to make sure part of the esophagus swallowing tube is down in the abdominal cavity. Frequently, in overweight patients, 100% of the esophagus is up in the chest and there is no anti-reflux mechanism. With part of the esophagus down in the chest, this will help prevent acid and bile from shooting up into the esophagus. The stomach lining can handle acid and bile. The esophagus cannot. Acid and bile can burn the esophageal lining which hurts and can even form cancer if left untreated for a prolonged period of time. The process of dissecting out the diaphragmatic crura and repairing the hernia at the time of surgery enables you to mobilize intra-abdominal esophagus and not only stop acid reflux disease but prevent it now that the stomach is much smaller in size.

Most surgeons ignore the hiatal hernia which is a problem. The other thing I see is improper suture being used or trying to tie the knots across a diagnonal instead of straight across and using interrupted instead of figure-of-8 suture. Like everything in surgery, there is a proper way to repair hiatal hernias which reduces recurrence. Some large hiatal hernias require a mesh patch and there is a proper way to do this as well.

We've done nearly 5,000 band surgeries over the past 8+ years and repairing hiatal hernias has done many wonderful things for band patients. Not only does the hiatal hernia repair stop their acid reflux, it also gives the band a nice sweet spot and allows us to tighten the band enough for weight loss without reflux.

Far too often, surgeons ignore the hiatal hernia with weight loss surgery or they repair it improperly and this causes much frustration and the potential for revisional surgery down the road. As you can imagine, the best time to do perfect surgery is the first time. A routine part of my plication procedure is to address the hiatal hernia properly and this maximizes weight loss while minimizing patient frustration and inadequate weight loss.

If a surgeon ignores the hiatal hernia with a plication surgery, the patient will have terrible heartburn and be very frustrated with eating and weight loss. I meet surgeons at meetings who argue that the hiatus is not that big of a deal but my experience is that it is a crucial part of a happy patient losing weight happily.

Brad Watkins MD

[NotSoLittleMermaid 14]

Thanks for the detail!

[itsabouttime 1]

Thanknyou Dr. Watkins, I appreciate your information. It sure helps.

[itsabouttime 1]

FitB450 - thanks for all your good suggestions. I plan to stay the three nights since I fly home alone and it is a four hour flight. I will take some meeds with me so I am all prepared. Sorry the follow up has been poor. I may mention it to them so they might make more of an effort. Only one week to go!

[Cknorte 7]

Good luck on your surgery.... Try to get an aisle seat so you can get up and walk a little during your flight home. Also don't be shy about getting a seat belt extender, if the normal seat belt is even a little tight on you now, your belly will be a little swollen from surgery, so you won't want a seat belt stabbing you... Also once you get through security, get some gatorade, G2 or Propel. The extra sugar and carbs will help on the long trip, you won't be getting too many calories in. Also, you may want to get some of that cup-o-soup, they have a chicken broth one, you can get a cup of hot Water on the plane and make a little broth. For me it had to be warm or cold. Anything room temperature was harder for me to tolerate the first few days. Good luck....

[itsabouttime 1]

Thanks for the input. I will be careful to hydrate and get some calories in. Airports are big places and I'll need energy to do all that walking. From what I have read on these post, I should be just fine. Here's hoping for no complications!

[NotSoLittleMermaid 14]

Wish you the best on your surgery! I am excited- made the decision and am set for OCT! Wish it was sooner, but friends and family are coming..

Let us know how it goes! We wish you a great surgery and fast recovery!

[saraslimmerin2011 0]

Dr. Teng,

I am having my lapband removed.

1. How long for it to heal ?

2. Which procedure leaves your tummy less bloated and swollen: The vsg or the vsplication ?

3.

Which is more efficient at weightloss ? I need to lose 60 pounds.

sara

[JoanieW 13]

Wish you the best on your surgery! I am excited- made the decision and am set for OCT! Wish it was sooner, but friends and family are coming..

Let us know how it goes! We wish you a great surgery and fast recovery!

Hi Amy. Good choice on surgeons. You won't be disappointed.

[NotSoLittleMermaid 14]

I am excited Joanie! Dr. Watkins and their staff has been really great and caring.

[itsabouttime 1]

Hi all,

Well I had my surgery with Dr. Corvala in TJ Mexico on Wednesday. This procedure is not a walk in the park. I have really felt lousy and have vomited several times. I am supposed to fly home tomorrow and I hope I will be up to it. Dr. Corvala and his staff have been great. I guess I thought it wouldn't be so uncomfortable. No real pain, just discomfort is the problem. I've been walking then sleeping, walking and sleeping. I just want those of you who are coming up to the surgery to be prepared. This is major surgery and there are no two ways about it. I'm not sure yet that I am glad I did this... Probably in a week I'll feel differently. I'll post again.

[Cknorte 7]

itsabouttime,

I'm sorry you are feeling lousy....it is major surgery and all of our bodies react differently. I was lucky I didn't throw up at all after surgery nor have I since I've been home. For me the worst time was the first night and the day after surgery. I just had horrible heartburn-type feeling, and like you I walked and slept and walked and slept. I had surgery on a Thursday and was on my way home on Saturday. Friday morning was tough and by Friday evening I was fine, and Friday I was good and Saturday I was ready to go.

It has now been 7weeks for me. I've lost 33 lbs, I've lost a ton of inches. I eat everything, normal foods without problem (Ok marinara sauce still is a little too acidy for me and gives me heartburn, but I'll eat it over noodles, since it is my favorite food ever, and I'll put up with the heartburn.....why I don't know....different story...think I need a shrink for that one.....

I eat anywhere between 1/2 cup to 3/4 cup of food or 4-6 oz of food.

It will get better. Dr. Corvala and the entire hospital staff are great. Remember to get all the info you will need, surgical report, diet, etc while you are there. Dr. Carmen the nutritionist is really nice, but not very good at answering emails. However everytime I have called after being home for random questions they are really good at getting back to me fairly quickly.

Hope you feel better soon. Keep us up with your progress. Remember you can ask them to bring you chicken broth for all three meals, that apple Jello and apple juice get really old. Also they can bring you grape juice or grape Jello, ask them for different flavors....they tend to love the apple flavor there. But their chicken broth is sooooo good!

Let us know and keep posting....

[itsabouttime 1]

Ckorte,

Thanks for your information. We do all react differently and that is just the way it goes. Another gal had the plication right before me and had awful sharp gas pains. She couldn't bird it up like I could therefore she was in tears with the pain. Now, two days later, she is doing tons better. I went for a walk to the pharmacy and outside cafe area to sit. It was so nice to be out of the room. My daughter came with me and she has been very impressed by the care here. When I first told her about it she wasn't sure, but now she sees how nice and clean everything is.

Tomorrow I fly home and will be on my own sice my daughter lives in CA. Hope it goes alright. I am going to take your advise and ask for a wheelchair. You really have been such a great source of information about the plication, thank you!

[Cknorte 7]

Make sure you get a gatorade or something to drink for the plane ride. Good luck,....it gets better pretty quickly.....

Stay safe.....