Further options for failed Endoscopic Sleeve

[Debbie Jeany 0]

Hi, I had an endoscopic sleeve gastroplasty last year in May, 2017. As no visible change occurred, my surgeon went back in after 6 weeks and did further surgery. He told me that my fundus had created holes and my pouch needed re-suturing.

I would like to point out that this is an excellent surgeon in arguably Sydney's best private hospital. There was no backyard shonky involved. The simple fact is, for me the surgery didn't work. A barium swallow showed that there is still a pouch of sorts with a small restriction but the fundus is completely open. In short, didn't work on me!

Are there any others like me out there? I've been told that I would have to have a gastric bypass now but a SADI has been suggested. Can anyone help me?

[Orchids&Dragons 9,047]

What do you mean that your fundus is open? Are the contents of your stomach leaking into your abdomen? Sorry, if I'm being dense, but I can't picture what you're describing.

[Frustr8 7,886]

Maybe she is unpleated where she should,be,pleated. This could make the muscles In the wall of her stomach not work,smoothly. Maybe the unpleated area gathers the food but doesn' t move it on, like an unresponsive pocket. Just trying to read between,the lines.👈😛👉

[Matt Z 4,140]

20 minutes ago, Orchids&Dragons said:

What do you mean that your fundus is open? Are the contents of your stomach leaking into your abdomen? Sorry, if I'm being dense, but I can't picture what you're describing.

Fundus means "Part of a hollow organ that is the farthest from the opening"

[Orchids&Dragons 9,047]

24 minutes ago, Matt Z said:

Fundus means "Part of a hollow organ that is the farthest from the opening"

Yes, I know that. I was confused about it being "open". I thought that part was cut away.

[Matt Z 4,140]

12 minutes ago, Orchids&Dragons said:

Yes, I know that. I was confused about it being "open". I thought that part was cut away.

Gottcha, I wasn't sure either, just posted the definition of the word... I think @Frustr8 might be right, they might have done a Sleeve Plication rather than the typical sleeve procedure and the bottom portion of the OP's "sleeve" has come apart and opened up. Not sure how it would "open up" otherwise... Guess we'll see what the OP says.

[Frustr8 7,886]

Nope you get gathered inside like the yoke of a Polly Flinders dress. Do they put those on little girls these days? My Sunday dresses all had slicked tokes until I put my foot down at 9 or 10 and refused to wear any more. Mama liked me dressed precious. White anklets, black patent Mary Jane shoes, at that age you don't worry,if they reflect up and little pastel dresses with smocking. There are pictures of me dressed to the nines either crossing my eyes or sticking my tongue out. You can be a dress up doll only so long before you rebel a little.

[RickM 1,753]

In our case, the fundus is the stretchy part that makes up most of the greater, or outer, curvature of the stomach, and is what is removed when a sleeve gastrectomy is done, or is folded up and tied back in a sleeve plication. It looks like with the endoscopic procedure, they suture it up internally to make the fundus inaccessible, leaving the reduced "sleeve" like path open for restricted food flow.

Being a fairly new procedure, one is fighting the learning curve - both for the individual surgeon and for the industry as a whole. The guys that did the first heart transplant were the best in the business, but the patient still only survived a short time; it takes time, practice and experience - both individual and collective - for a procedure to mature into a routine, everyday therapy, so your doc may well be exceptional, but they are all still working out the kinks in a new procedure.

Where to go from here? A bypass was suggested, and this is very common, as most bariatric surgeons were raised on them, so to speak, know them well and tend to be very comfortable with them when things get complicated as they can with some revisions. You note that a SADI has been suggested - was this by the same surgeon, or someone else? If the SADI is a possible, then a regular sleeve gastrectomy should also be workable, as the SADI normally uses the sleeve as its basis, and presumably that would be most attractive to you as that is what is most similar to your originally chosen endo sleeve. Whether you need the malabsorptive component of the bypass or SADI is an individual decision.

When things get complicated like this, it is usually best if one can get a second (or even third) opinion on the problem and possible solutions. There are often several different alternatives available, but individual doctors will prefer, or have more experience, with one over another, while another doc may have different experiences and preferences as to how to approach this problem.

Good luck in working this out...

[Orchids&Dragons 9,047]

42 minutes ago, RickM said:

In our case, the fundus is the stretchy part that makes up most of the greater, or outer, curvature of the stomach, and is what is removed when a sleeve gastrectomy is done, or is folded up and tied back in a sleeve plication. It looks like with the endoscopic procedure, they suture it up internally to make the fundus inaccessible, leaving the reduced "sleeve" like path open for restricted food flow.

Being a fairly new procedure, one is fighting the learning curve - both for the individual surgeon and for the industry as a whole. The guys that did the first heart transplant were the best in the business, but the patient still only survived a short time; it takes time, practice and experience - both individual and collective - for a procedure to mature into a routine, everyday therapy, so your doc may well be exceptional, but they are all still working out the kinks in a new procedure.

Where to go from here? A bypass was suggested, and this is very common, as most bariatric surgeons were raised on them, so to speak, know them well and tend to be very comfortable with them when things get complicated as they can with some revisions. You note that a SADI has been suggested - was this by the same surgeon, or someone else? If the SADI is a possible, then a regular sleeve gastrectomy should also be workable, as the SADI normally uses the sleeve as its basis, and presumably that would be most attractive to you as that is what is most similar to your originally chosen endo sleeve. Whether you need the malabsorptive component of the bypass or SADI is an individual decision.

When things get complicated like this, it is usually best if one can get a second (or even third) opinion on the problem and possible solutions. There are often several different alternatives available, but individual doctors will prefer, or have more experience, with one over another, while another doc may have different experiences and preferences as to how to approach this problem.

Good luck in working this out...

Thank you for the excellent explanation!

[Hop_Scotch 1,634]

Did you by chance have a gastric balloon before the ESG? I am hoping to have the ESG and the doctor told me he no longer does them for anyone who has had a gastric balloon as the failure rate has been high due to the stitches not holding/loosening. The research as yet to determine why but he thinks may be due to the balloon stretching the stomach tissues.

I am sorry you have gone through this, hopefully there is an option for you for a successful revision. On a FB group I belong to, some who haven't felt sufficient restriction have revisioned to a VSG or bypass. I would think in Australia as the ESG was introduced less than two years ago, there wouldn't be too many revisions as yet.