anastomosis erosion

[AZhiker 2,251]

I met 2 people this week who were long term gastric bypass patients (15-20 years out). Both had erosion/bleeding from one of the anastomosis sites and ended up in the hospital. Is this something that is very common? I sure hope not. Anyone have any data or sources for this type of complication? I would have thought once the sites were healed they would be good for life. But apparently for some folks that is not the case. Just wondering if there was a difference in how older surgeries were done compared to techniques today.

[catwoman7 10,856]

I've never heard of that - but then, the surgical techniques they use now are much improved over what they used years ago...

[RickM 1,747]

I am not sure what is meant by "erosion" in this context, but the RNY anastomosis is something of a delicate structure owing to its environment. The part of intestine that the stomach pouch is joined to at that point is not resistant to stomach acid, as the duodenum is (that's the part of intestine immediately downstream of the stomach in the normal anatomy, and is resistant to stomach acid, but is bypassed along with the remnant stomach in the RNY). Consequently, the anastomosis is often under frequent or constant irritation from the acid, and sometimes never completely heals, and can in some cases be a continual source of minor blood loss or weeping. This is also the point where ulcers usually occur (the so-called "marginal ulcers" that are a predisposition of the RNY) and is the origin of the "no-NSAID" rule that permeates the bariatric world. I don't have any particular studies or sightings on this, but it was something we covered in our pre-op education seminars.

Techniques do indeed improve over time; for instance, bile reflux used to be relatively common with the bypass, but careful adjustments to the limb lengths seems to have minimized that. And, when my wife and I were first looking into WLS some 15-16 years ago, we found references to the matter that endoscopic dilations of the stoma had become so common that they ceased being considered a "complication", but just SOP; that doesn't seem to be that common these days as I have seen very few references to that being needed, so they seemed to have figured out the "just right" sizing compromise for it.

We tend not to get the whole story when we run into these occasional problem cases, either in person or online - were they doing everything "right" or were they getting lax on some of the rules (this is not helped by many practices that fail to distinguish between early post op rules for good weight loss and "forever" rules to ensure proper long term health and function,) - did the patients, for example, get tired of ineffective pain relief for their arthritis and start hitting on the Naproxen (an NSAID) for better results?

[Frustr8 7,886]

They very possibly could have, when YOU are in pain ,often you don't have the Brain God Gave A GOPHER! I finally figured out the source of my very first ulcer, Hector, that I brought into the RNY mix. Ok, I have been " cheery" every since I was a small child, every cold virus visits my lungs and engenders mucus to get rid of. My PCP gave me frequently Capmist, a lovely expectorant, got rid of my lung mucus but had the effect of minimizing if not destroying my gastric mucus layer. At the same time, I was also having arthritis flares, I am the unhappy possessor of both varieties, Osteo and Rheumatoid. Orthopedic surgeon says Take Advil and since you are such a BIG Girl take then every 4-hours! Well both doctors are Graduates of very reputed Colleges of Medicine, did I question THEM? Nope, just kept on until Hector showed up and. nearly chewed a hole through my Gastric Well. When I consulted my. Gastroenterologist, he was almost perforated, and I was on Omeprazole therapy at that time. It DOES NOT WORK for me!
Okay fast forward to Surgery last September 5th, that went well but among my post- surgeries is my non-friend Omeprazole, I told them at that time, we are Going to have problems,it isn't going to be Gastroprotective! Please let me take Dexilent which does work for ME! I was told the professional equivalent of "Please shut up and give the meds we have ordered a chance to work, we are the educated and licensed individuals. Give yourself the chance to heal and heal correctly!" Well I am nothing but compliant, I took each med faithfully and at proper intervals. Even opened the Omeprazole capsules and sprinkled it in a teaspoon of unsweetened applesauce, that was the excuse Shannon one of the NP gave me for Omeprazole instead, shoot I could have cut my 60 mg capsules,of Dexilent open and shook it on! Well 2 weeks in I started fussing, told them" I am starting to get,ulcer symptoms again!" been there before, knew WHAT it feels like. And every Man-Jack said I was delusional. I was not giving my new pouch a chance to heal properly, I was being nothing but a pain in the backside! Finally at 6 weeks, I suspect to Shut up my Mouth, they scheduled an Endoscopy, that was October 12th, went peacefully to sleep, when I awoke Dr Noria, my surgeon's Junior Partner, who does their endoscopies because she likes doing them, shook my hand and stated " You were correct, you have a very irritated pouch, 2 ulcers within and severely stenosed, that's why you are frequently having emesis, it's like a pin-hole, only liquids make it through. If that isn't enough you have 5 additional ulcers on the back wall of your jejunem, and those do look wicked, I will be giving you script for Carafate, every 6 hours around,the clock,we will get,on top of this but I was not able to dilate your stomal opening today" well I started having attempts at 2 weeks, a month later, the end of the month of November I was hospitalized for a week because I was malnourished and Protein anemic, that's when I received my PICC line, was fed TPN every 12 hours to Give my GI,system a chance to heal and THAt was a 3 months duration, in that time I still was receiving frequent endoscopies, I have now had a lifetime total of 13, 10 with Dr Noria, and now it is believed one more and it should stay open. I would have stented ME before now, started me on Carafate from the start since I was a proven Ulcer Producer, but I don't have the medical licenses, certification of surgical skills, I am only the sufferee, But I see a future, there is hope for me AHEAD and they feel by September I should be over this all. After final endoscopy which should be June or July 4th at latest, at my next visit in August. the final decision will be made, whether further surgical intervention is needed or whether. I have completely become open , functional and ulcerations are healed. But at this point, betting odds are 8 to 5 further surgical repair. I know this was long but now you and all the readers know how things stand with the World's Oldest RNY recipient and No, despite everything in my bumpy path, I DO NOT REGRET MY BARIATRIC surgery, I have a lot more. of Life Achievements Ahead.

[Frustr8 7,886]

And I was Chesty not merely Cheery, although I Do Try!

[Bari_KS 499]

Marginal ulcers at the gastrojejunal anastomosis are a rare and serious post-operative complication of RNY gastric bypass seen in 0.3 - 1.5% patients. Ulcers are produced as a result of partial erosion of the jejunal or gastric mucosa caused by acidic stomach secretions. This is most commonly due to an incomplete staple line on the gastric pouch or tension placed on the anastomosis, although the exact etiology remains unclear. The incidence of marginal ulcer is said to be exacerbated by risk factors such as smoking, alcohol intake and steroid use.
Info from Google.

[Briswife15 889]

Well, I have a marginal ulcer as well as severe stenosis of the stoma. Not sure exactly how rare they are, but I don't smoke, drink or take NSAIDS, and my surgeon is top notch. Just one of those things!

Sent from my SM-N960U using BariatricPal mobile app

[Frustr8 7,886]

And I also do not drink, smoke or take NSAIDs any longer, to put it even more seriously I am not allowed to be in the,presence of an Active Smoker as the actual smoke as well as the residue,on their clothing could worsen mine.Makes me somewhat,of a Social Pariah, I now wear a jelly Bracelet that states " Secondhand Smoke Kills" in case someone queries me. Ah, it is what it is, my friends!😭😪😥💦

[mgrand 81]

The nurse just informed me of the fact that secondhand smoke can cause ulcers at my 2-week post-op. I wish I had been more aware of this before surgery since I live with a houseful of smokers!

[dparciak 4]

I have followed my surgeon's directions to the letter. I just had my second endoscopy two days ago and I'm only 8 weeks out. I was told I "make great scar tissue!" Probably won't be my last endoscopy with dilation. Just hope I can finally get this to stop at some point. No telling who is going to get a stricture and who isn't.

[Briswife15 889]

I have followed my surgeon's directions to the letter. I just had my second endoscopy two days ago and I'm only 8 weeks out. I was told I "make great scar tissue!" Probably won't be my last endoscopy with dilation. Just hope I can finally get this to stop at some point. No telling who is going to get a stricture and who isn't.

Yup! Getting ready for my second endoscopy with dilation tomorrow. Stricture started closing up 3 days after first dilation. I'm sure there will be more in my future, too. Never got out if the liquid stage and I'm 6 weeks out.

Sent from my SM-N960U using BariatricPal mobile app

[Frustr8 7,886]

Well welcome @dparciak to our little exclusive club! Don't mean to sound totally flippant, just trying v to smile through my tears 💦😭. Met yesterday with my Bariatric Dietician Roy, yeah I have a male one- but he is good one. We went over diets to formulate one that will give me the most for my bucks. See there are things, try as I may, my rebel pouch the ever'present 👓Ms Precious Pouch, will not sanction within herself so we have found substitutes for each item. And sad to say, about 6 were things that were my go- tos before she was born of a scrap of my stomach tissue last September 5th. Oh I do try a small spoon of each about once a week, but they are all No Go still at 8 months in.👕