Sleeve Construction Problem!?

[RichardVST 20]

So I have been whining about my sleeve ever since I went on solids. My surgery was at the end of Feb13. I get that bloaded feeling everytime I eat and regardless of how much or how slow. Now I am getting lost of heartburn and hunger pain, especially when my stomach is empty. It even wakes me up at night. I have been assuming that it would get better with time but now at 9 months I decided to get it checked. Had an Upper GI (yuk) and it came back normal, with one exception that there was a narrowing between the upper section of my pouch and the lower...? I never knew there were two sections. Looking at the xray, my stomach kind of looks like a barbell..? The surgeon said that food could be getting stuck in this narrowing. Her off the cuff solution was to 1st get endoscopy, and think about converting my sleeve to an RnY!!! Yikes I was blown away! Does anyone know anything about the anatomy of our new pouches? Does it make any sense that the new pouch would actually be more like two with a narrow passage between the two? Does it sound like my surgeon screwed up? HELP? Thanks

[Catherine707 253]

Sounds like you are dealing with a stricture. It could be a surgical error, or you could have developed scar tissue. I think I would take my upper GI results and get a second opinion from another bariatric surgeon before I had surgery again with the first surgeon.

To answer your question, the new stomach should look like a banana, not a bar bell. Gastric sleeve surgery does not usually yield two separate pouches.

You have had good weight loss, but the symptoms you describe do need to be addressed. Get a second opinion and then decide if you want to use the same surgeon again or go with a different one!

Good luck!

[Hidden from view 159]

Have you tried a Proton Pump Inhibitor? That could solve the heartburn problem. My surgeon discharges everybody on a PPI and I expect to have to take it forever. It's just a capsule. The PPI also reduces the sensation of hunger. The shape of the sleeve doesn't really matter as long as it is functioning OK. I would try a PPI before I tried further surgery.

[No game 14,436]

Can you please explain pouch? Are you talking about the sleeved stomach?

Pouch is something more gear towards RnY patients..

[No game 14,436]

Ok did a little reading and it does seem to happen to the stomach in certain cases

Surgeon technique: regardless of bougie size, there are still surgeons out there that are starting the staple lines several centimeters from the valve at the esophagus at the top and the pylorus at the bottom. One patient who saw her sleeve in a scan described it as "barbell shaped" - it had a large pouch at the top and bottom, then went down to just the size of the bougie between. This has a huge impact on restriction and involves very stretchable tissue.

[Ms.AntiBand 2,984]

Why would a surgeon opt for this type of shape/stapling? Seems like it would invite issues

[No game 14,436]

I think he's right it's a sleeve construction issue. I was reading that some sleeves from years gone by were constricted like this and it was no bueno..

[sifford1 27]

My dr office explained tht there is no standard on the way they do sleeves! My dr leaves a little more room at the bottom because he believes it decreases the chance of food becoming stuck, so mine prob looks like a half barbel! My nurse said if I'm not careful in following the food steps it can cause sleeve damage! I to suffer from the same feeling, gas pain ,bloating ,and so on at 4 weeks out! My nurse will only allow me to take maalox right now, but I read a lot of people's stuff who suffer the same way , and they all say Prilosec is a miracle once your able to eat solids!

[RichardVST 20]

Thanks everyone for the replies. To answer some of the questions. Yes I have been on prilosec/omerprazole and zantac since surgery. Plus I drink Maalox and drop tums all the time. I even tried other PPIs. Nexium gave me a rash - strange. The pouch term was mine - technically I think its called the boughie...? I got an Upper GI and saw the xray and there definitely were two pouches with a very narrow tube in between. It looked tiny and the Radiologist who did the test said that everything was normal, except he noted a mild narrowing....I The surgeon I saw, was the partner of the surgeon that did the sleeve, but that's not exactly objective. I really would not like to get a RnY. Things would have to be a lot worse for me to consider that...But I do need to get the heartburn under control or I could have a problem. I am going to get the endoscope so they can see how truly narrow that passage is. Based on that I will weigh my options. I probably will have another surgeon look at my xrays and scope films to see if anyone things I got screwed by my surgeon. I'm very disappointed, though I must say. Thanks again everyone.

[mich 74]

Sorry you are having troubles. I have a funky shaped sleeve too. I was a band revision. My surgeon asked me to do a swallow test post op in hospital so they could document my sleeve shape. He said they want more documentation on new procedures, I think I was his 5th band to sleeve.

Anyway, pre op I had been reading about maintaining the pyloric antrum, and possible reduction in long term heartburn post sleeve. I understand that how much of the Antrum is left is not a standard practice. My surgeon said that yes they maintain the Antrum. So I imaging my sleeve has a wider area at the bottom. And because of all the tissue damage from the band a funky area at the top also. No banana shape for me.

Hopefully they can dilate your narrowing and you will feel better!

[Ms.AntiBand 2,984]

Wow Mich... You were a brave soul to be a fifth patient of a surgeon. I too had extensive damage from the band, but my surgeon required 18 month healing before sleeving me. On viewing my second precautionary leak test I saw I have a perfect banana shape sleeve.

I honestly believe the shape has to do with the skill of the surgeon. Just my opinion, but that's what I believe.

[mich 74]

Wow Mich... You were a brave soul to be a fifth patient of a surgeon. I too had extensive damage from the band, but my surgeon required 18 month healing before sleeving me. On viewing my second precautionary leak test I saw I have a perfect banana shape sleeve.

I honestly believe the shape has to do with the skill of the surgeon. Just my opinion, but that's what I believe.

There was certainly a good amount of faith on my part. But I felt like I was in good hands, he has mountains of experience, is chief of bariatrics and is a great surgeon. There is just not a lot of call for revisions in my area. I'm three months out now, I feel great, no problems, losing weight, and loving all the foods I can eat now that the wretched band is gone!

I love my sleeve, it's just a bit unique, like me!

[RichardVST 20]

Wow! Good for Mich...I personally would never really trust a surgeon....

[slvrsax 301]

Wow Mich... You were a brave soul to be a fifth patient of a surgeon. I too had extensive damage from the band, but my surgeon required 18 month healing before sleeving me. On viewing my second precautionary leak test I saw I have a perfect banana shape sleeve.

I honestly believe the shape has to do with the skill of the surgeon. Just my opinion, but that's what I believe.

I've been told the same thing - that the shape of the sleeve has to do with the skill of the surgeon. I was also told that a misshapen sleeve can hold more food later and could make maintenance more difficult.

[Cabingirl 55]

Experience, or the number of times the surgeon has performed the specific operation, is one of the key indicators for a successful patient outcome, along with the surgeon's board accreditations.

A certified Bariatric Center of Excellence is another positive because of the standards/requirements to achieve certification.