HI THERE,

SO I AM ALMOST 1 YR POST OP AND ONLY 48-50 LBS DOWN. NOT CLOSE TO MY GOAL AND ACCORDING TO MY BARIATRIC DR, MY SUGERY IS A FAILURE. MY SURGERY WAS DONE IN HONOLULU HAWAII BY AN DIFFERENT SURGEON. I NEVER HAD A POST OP VISIT SO THIS MEETING LAST WEEK WAS MY FIRST POST OP APPT. THE DR THINKS MY SLEEVE MAY BE TOO BIG BECAUSE I'M DOING EVERTHING ELSE RIGHT... I'M DESPERATE TO KNOW IF IT WAS ME THAT WAS THE FAILURE OR THE SURGEON WHOM MADE MY SLEEVE TOO BIG.... HAD AN UPPER GI MONDAY AND HAVE RESULTS BUT NO DR CALL YET... CAN ANYBODY DECIFER THIS? HE WAS DOING THIS TO SEE THE SLEEVE AND TO GET INSIGHT IN TO HTE SIZE. I DON'T SEE ANYTHING ING THE RAD REPORT THAT GIVES A HINT EITHER WAY.

HERE IS WHAT I HAVE FROM THE RADIOLOLGIST REPORT:

Narrative

CLINICAL INDICATION: patient with h/o sleeve gastrectomy May
2014, poor weight loss despite adequate activity, need to eval size
of sleeve and emptying

EXAM: UPPER GI WITH KUB

COMPARISON: None

Technical factors: Patient consumed barium in a standing AP and
oblique projection. Recumbent demonstration was performed.
Fluoroscopic observation and numerous overhead static images were
obtained. One minute of fluoroscopy time utilized.

FINDINGS:

The swallowing mechanism is intact. Esophageal motility is normal. No
detected hiatal hernia nor gastroesophageal reflux. There does appear
to be mild circumferential narrowing of the body of the stomach. No
focal mucosal abnormality. No contrast extravasation. Duodenal bulb
and loop are normal. In the proceeding satisfactorily.

Impression

IMPRESSION:
1. Mild circumferential narrowing of the mid body
2. No contrast extravasation mass inflammatory change or delay in
gastric emptying noted
3. No esophageal abnormality

Component Results

There is no component information for this result.

General Information

Collected:

03/23/2015 8:30 AM

Resulted:

03/23/2015 9:45 AM

Ordered By:

William Van Rice, MD

Result Status:

Final result

This test result has been released by an automatic process.

ANYONE SEE ANYTHING THAT MIGHT HINT TOWARDS A NORMAL SLEEVE OR ABNORMAL SLEEVE OR IT'S TOO BIG! LOL I'M DESPERATE. THIS IS THE DEFINING REPORT THAT TELLS ME WHY I'M NOT LOSING AS I SHOULD. I'VE WORKED SO HARD AND SO LONG AND THIS DR IS TAKING FOREVER TO CALL BACK! LOL

I don't know what all that means but I think the good news is there is nothing acutely wrong.If the sleeve is too big will they modify it surgically? Hang in there and I hope you get answers soon.

You can't tell from that. It pretty much says you have narrowing of your mid stomach from the sleeve, it's doesn't say the amount of narrowing ..looks like you will have to wait on the dr who has your x-rays and can compare the size to a normal stomach. That report pretty much says everything is normal but nothing in regards to the actual size of your stomach besides "Mild circumferential narrowing of the mid body". That's not saying much.

My take on it is that Per the radiologist your stomach and digestive mechanisms are all normal and doing what they should be. What will probably happen is your dr will look at the pictures to see what the size of the stomach is.

Thanks for the responses... I was thinking the same thing! This says nothing. The one thing that stuck out is that it states "mild narrowing"... I would think that it would more than mild?? Either way I am healthy so that is a great thing:) I'm just continuing with the program and hope that I will lose again. I stopped at about 5 months our. I have been super frustrated but now that I finally can see somebody again I'm excited and thankful. If it's too big, yes the MD said he'd be open to a revision. Not sure I want that but I'm willing to look at it as an option. PS starting weight at time of surgery was about 260 lbs?

Edited March 25, 201511 yr by SOPHIAAGETTYS80

Thanks for the responses... I was thinking the same thing! This says nothing. The one thing that stuck out is that it states "mild narrowing"... I would think that it would more than mild?? Either way I am healthy so that is a great thing:) I'm just continuing with the program and hope that I will lose again. I stopped at about 5 months our. I have been super frustrated but now that I finally can see somebody again I'm excited and thankful. If it's too big, yes the MD said he'd be open to a revision. Not sure I want that but I'm willing to look at it as an option. PS starting weight at time of surgery was about 260 lbs?

Edited March 25, 201511 yr by SOPHIAAGETTYS80

Yep all that says is the GI test found nothing unusual. You say you did everything right.

What's a typical food day for you?

How much Protein are you getting?

How much exercise do you do?

How many calories a day are you eating?

Approximately how much do you need to lose?

How old are you?

I think I can add to this discussion. I do so without the benefit of seeing the actual report, the actual images, examining you, etc.. Given that:

That it reads: "Mild circumferential narrowing of the mid body,"... it doesn't seem that you had a complete sleeve; i.e., it wasn't done the full length of the stomach. You don't have a "banana"-shaped stomach, a narrowed, tubular-shaped stomach, as you now should.

Get the op note--the "operative report/note"--from your surgeon. See what size bougie he/she used. But it ~seems they left your stomach too big, didn't really cut the full length of it, and only narrowed a portion of your stomach. With that, you likely still have a lot of ghrelin circulating [hunger hormone], and of course, greater stomach capacity. The greater curve of the stomach may not have been excised.

Also get any "discharge summary" --in fact, get ALL your records from your surgeon, to give to your current doctor. And if you have any previous stomach imaging reports, they'd make for a good comparison. Also, there should be a pathology report of your excised stomach portion; it'd be interesting to see its size. Again, request ALL your records from the surgery.

The good news: no abnormalities are noted, and you have lost ~ 50 pounds...though I know you'd expected more pounds lost by now.

Get those records; keep doing what you're doing and see what the new doctor says, and what any future imaging reveals. Keep us posted.

Edited March 25, 201511 yr by Dr-Patient

I'm currently eating 12-1300 cals a day... I can eat about 1 Lean Cuisine serving size easily. I work out 5-6 times a week for at least 30 mins. Training currently for a 10K. I'm a wellness ambassador at work to keep me on point and accountable as well as helping others. I get 50-70g of protien/day... I'm following the bible I got from my surgery program in Hawaii from Kaiser. I don't eat bread, rice or Pasta at all. No sodas, very little caffine and a ton of Water daily. I keep a journal and am working with a dietician too. I'm 34 and was told I should have lost 85-99 lbs from the MD I saw here in NM. He threw a lot of #s at me to get to that amt but he'd expect this from his patient with my presentation of size. I would love to be under 200 lbs. I've lost this 50 lbs like 5 times in the last 5 yrs... I would love to hit 150-160 and would feel good I think. I just want to run! I want run Boston. I've run NY and Chicago full marathons at 230 and 250 lbs... It took almost 8 hrs to complete them and I need to be way faster to do Boston. That's one of my goals. I don't have goals of pant size or bikinis I want to DO things:)

Well, you're on the right track to find out what's going on.

Soon you'll have your answers from the doc. I hope you return here and post what she/he says.

Best to you!

Do you track your food daily? Are you inputting everything you eat? Are you getting in your fluids? How many carbs/fat grams do you average?

Do you feel restriction? How many ounces of Protein can you eat in a sitting?

70gr of protein for 1300 calories seems low, but without your typical diet, there's no way to see if what you are eating is affecting your weight loss.

Are you still losing? Do you take your measurements as well as weigh yourself?

I have a large sleeve, it literally does nothing to help me. My doc used a 42 bougie and went loose due to the scar tissue from my band and it easily stretched out quite a bit. I've got my x-rays to prove it looks nothing like any other "sleeves" I've ever seen. I've done a ton of research on this and I'm pretty sure that narrowing through the middle which can create an hour glass shape is sometimes a post op "complication" of the sleeve, i say complications however obviously it's not causing any issues, it's just not the desired outcome. I'm currently looking into options to revise. Best of luck to you !

A lean cuisine meal isnt the most nutrious meal you can have.....contains alot of sodium which makes you hold Fluid and not lose weight. ALSO, some people lose weight slower than others. Personally, I woud go back and start over. Start a 5 day liquid diet, then go up to soft foods and stay in the 1000-1200 calorie range, 70-80 grams of Protein, no more than 50 grams of carbs a day. GOOD LUCK & I hope everything works out for you!!

You know, if it were me, I would want answers, too. Do you have insurance? Would you be interested in having additional opinions from other surgeons? If so, I would suggest a second, third...opinion from different doctors, from different hospitals so you get all the answers you need. And call the insurance company who covered this for you, if you used them. Ask their opinion, and if they cover second...opinions. It can't hurt. Also ask the insurance if they cover a potential second surgery, especially if there was an error done by the doctor. You'll need to have all your ducks in a row for this, so start documenting EVERYTHING, and keep copies of everything. Good luck to you, and let us know what happens!

I think I can add to this discussion. I do so without the benefit of seeing the actual report, the actual images, examining you, etc.. Given that:

That it reads: "Mild circumferential narrowing of the mid body,"... it doesn't seem that you had a complete sleeve; i.e., it wasn't done the full length of the stomach. You don't have a "banana"-shaped stomach, a narrowed, tubular-shaped stomach, as you now should.

Get the op note--the "operative report/note"--from your surgeon. See what size bougie he/she used. But it ~seems they left your stomach too big, didn't really cut the full length of it, and only narrowed a portion of your stomach. With that, you likely still have a lot of ghrelin circulating [hunger hormone], and of course, greater stomach capacity. The greater curve of the stomach may not have been excised.

Also get any "discharge summary" --in fact, get ALL your records from your surgeon, to give to your current doctor. And if you have any previous stomach imaging reports, they'd make for a good comparison. Also, there should be a pathology report of your excised stomach portion; it'd be interesting to see its size. Again, request ALL your records from the surgery.

The good news: no abnormalities are noted, and you have lost ~ 50 pounds...though I know you'd expected more pounds lost by now.

Get those records; keep doing what you're doing and see what the new doctor says, and what any future imaging reveals. Keep us posted.

I think this is good advice for anyone having any surgery or medical procedure. You might be surprised at what is in your operative report. I know I was when I got mine and found out my surgeon put in a 4cc band when he told me it was 10cc.

I have an accordion folder of all my medical records. If the doctor sees it, so do I.

A lean cuisine meal isnt the most nutrious meal you can have.....contains alot of sodium which makes you hold Fluid and not lose weight. ALSO, some people lose weight slower than others. Personally, I woud go back and start over. Start a 5 day liquid diet, then go up to soft foods and stay in the 1000-1200 calorie range, 70-80 grams of Protein, no more than 50 grams of carbs a day. GOOD LUCK & I hope everything works out for you!!

You know, it's funny, because even those in the medical/health care profession who deal with WLS (or just weight loss in general) before and after are not all on the same page with regard to food that is okay and food that is not okay. My NUT before my lap band surgery had a room full of empty boxes of the frozen diet dinners along with the requisite plastic food. These were all foods you were encouraged to eat and their portions.

Edited March 26, 201511 yr by Cleo's Mom