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Sleeve complications possible revision to bypass



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Hello everyone this is probably going to be long but really could use the input.

Nov 2019 I had the gastric sleeve done. Since this I have had nothing but troubles. 10 days after surgery I was admitted due to blood in my belly and a hematoma on my spleen. They fixed that and discharged 3 days later. I have not been able to eat much more then let's say a chicken nugget(less then an ounce of anything including liquids)

I got dehydrated was admitted again 29 days post op. Stayed for 12 days got a picc line with tpn since I can not eat or drink much. During this stay had endoscopy and they stretched a stricture lower part of stomach to intestines from 15mm to 25ish mm. Went home no change still not able to eat.

Had another endoscopy and stretch this time my stomach was twisted and she tried stretching to 30mm but was only able to get to about 28mm. Went home still no change to eating and drinking.

On the 16th of January I had another endoscopy stretch. Stomach was twisted again and was barely able to stretch it at all. I aspirated during the procedure. I woke up to them telling me to keep coughing to get it up. They observed me for 3hrs was on 4liters of oxygen at first then 2. I got up to pee with help my oxygen corrected itself. They said there was no need to keep me I only aspirated a tiny amount. They let me go home (2 hr drive home) I was freezing hole way hubby cranked up heat. Took temp when I got home and found I had a fever of 102.6 went to local er where they did xray and ct found I had developed pneumonia and I also had a pulmonary embolism. They felt I should go back to hospital where this happened and I stayed there for 6 days. 5 days of iv antibiotics and heparin for embolism then discharged on lovonox to continue for 6 months to a yr.

I still have no change so now its crunch time it has been 3 months since and cant eat or drink much at all. They want to do another stretch which I would need to come off the lovanox which is putting my life at risk. Not to mention I have had it done 3 times and it has not helped. Also if it doesnt work i would need to have the bypass revision which means 2 procedures putting me at risk 2 times) Surgeon says only other option is revision to bypass(unless he sees scar tissue and can fix. But i have to agree to bypass incase there is no scar tissue or it cant be fixed)

My family is up in arms it's hard either way. I dont want anymore procedures but I need to get stomach fixed and I need to get back to work. 3 months no pay we cant take this financially anymore. So for me I feel like they need to do the bypass and I hope for the best and have minimal complications. However the rest of family is worried I will have more complications than I have currently. Plus my sister had bypass and has had to have 15 different repairs(this makes them more worried)

I could really use some insight on this what would you do? What do you think I should do?

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I'm so sorry to hear about all your complications. Can I ask where you and your sister had surgery? You've both had a lot of problems. I had the sleeve in 2011 and then had horrible acid reflux. I revised to the mini bypass because I was told that would fix it. I'm one of the few unfortunate ones that it didn't fix and got way worse. I'm 6 days post op with a revision to rny. So far no complications and no acid reflux. If I were you I'd probably get the rny with a different surgeon than you had the first time. Good luck.

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1 minute ago, bikerchick519 said:

I'm so sorry to hear about all your complications. Can I ask where you and your sister had surgery? You've both had a lot of problems. I had the sleeve in 2011 and then had horrible acid reflux. I revised to the mini bypass because I was told that would fix it. I'm one of the few unfortunate ones that it didn't fix and got way worse. I'm 6 days post op with a revision to rny. So far no complications and no acid reflux. If I were you I'd probably get the rny with a different surgeon than you had the first time. Good luck.

We both had 2 different surgeons and hospitals. I love my surgeon. He and his team have been great and trying to fix this.

What is difference between bypass and mini bypass? Glad you are doing well!!

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Just now, Ttyo said:

We both had 2 different surgeons and hospitals. I love my surgeon. He and his team have been great and trying to fix this.

What is difference between bypass and mini bypass? Glad you are doing well!!

with the mini bypass they only make one anastomosis so it's a quicker, safer surgery, With the RNY they make two anastomosis (where they bypass the intestines).

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Anytime that I see someone contemplating a revision, I would advise getting a second (and even third) opinion, both from the perspective that revisions are typically more complicated than a virgin surgery, and also the reasons for the revisions are more varied, and this is where the perspectives of different surgeons with different experiences is most valuable. Strictures and twists like you are describing are an indicator of technique problems (which isn't to say that there is something particularly quirky with your individual anatomy that would have caused problems with any surgeon, just that they are frequently associated) so it is quite possible that another surgeon who is more experienced specifically with the sleeve and sleeve related surgeries may have some other ideas of how to tackle your problem.

There are some surgeons out there who routinely perform some very complex revisions (such as converting a problematic RNY to a DS) and this is the type of doc that you would like to consult with, as they would be best able to straighten out your sleeve (and if they concur that an RNY is the best approach for your particular problem, that provides a lot of confidence in deciding to go that route.)

I tend to like DS surgeons for sleeve problems as they typically have a lot more experience with the sleeve and correcting sleeve problems (as the sleeve is a part of the DS, most of them have been doing sleeves for over twenty years, while most bariatric surgeons have been doing them part time for 5-10 years, and some less.

https://www.dsfacts.com/duodenal-switch-surgeons.php gives a very incomplete listing of DS surgeons, and unfortunately, there aren't any very close to you - NY/NJ/PA area is the closest, but probably worth the effort; most can do initial consults over phone and email. Dr. Roslin in NYC and Dr. Greenbaum in NJ both have good reputations in the DS world for complex revisions.

As a side note, the mini bypass isn't often done in the States as US insurance rarely approves it, and it has never been accepted by the ASMBS.

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6 hours ago, RickM said:

Anytime that I see someone contemplating a revision, I would advise getting a second (and even third) opinion, both from the perspective that revisions are typically more complicated than a virgin surgery, and also the reasons for the revisions are more varied, and this is where the perspectives of different surgeons with different experiences is most valuable. Strictures and twists like you are describing are an indicator of technique problems (which isn't to say that there is something particularly quirky with your individual anatomy that would have caused problems with any surgeon, just that they are frequently associated) so it is quite possible that another surgeon who is more experienced specifically with the sleeve and sleeve related surgeries may have some other ideas of how to tackle your problem.

There are some surgeons out there who routinely perform some very complex revisions (such as converting a problematic RNY to a DS) and this is the type of doc that you would like to consult with, as they would be best able to straighten out your sleeve (and if they concur that an RNY is the best approach for your particular problem, that provides a lot of confidence in deciding to go that route.)

I tend to like DS surgeons for sleeve problems as they typically have a lot more experience with the sleeve and correcting sleeve problems (as the sleeve is a part of the DS, most of them have been doing sleeves for over twenty years, while most bariatric surgeons have been doing them part time for 5-10 years, and some less.

https://www.dsfacts.com/duodenal-switch-surgeons.php gives a very incomplete listing of DS surgeons, and unfortunately, there aren't any very close to you - NY/NJ/PA area is the closest, but probably worth the effort; most can do initial consults over phone and email. Dr. Roslin in NYC and Dr. Greenbaum in NJ both have good reputations in the DS world for complex revisions.

As a side note, the mini bypass isn't often done in the States as US insurance rarely approves it, and it has never been accepted by the ASMBS.

Thank you for all that information! I'm just concerned with taking more time to find a 2nd and 3rd opinion. I feel like 3 months of this has been too long. I will look into a phone or email consult with one or 2 of these. Fingers crossed they will get back to me :) thanks again for all that info!

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11 hours ago, Ttyo said:

Hello everyone this is probably going to be long but really could use the input.

Nov 2019 I had the gastric sleeve done. Since this I have had nothing but troubles. 10 days after surgery I was admitted due to blood in my belly and a hematoma on my spleen. They fixed that and discharged 3 days later. I have not been able to eat much more then let's say a chicken nugget(less then an ounce of anything including liquids)

I got dehydrated was admitted again 29 days post op. Stayed for 12 days got a picc line with tpn since I can not eat or drink much. During this stay had endoscopy and they stretched a stricture lower part of stomach to intestines from 15mm to 25ish mm. Went home no change still not able to eat.

Had another endoscopy and stretch this time my stomach was twisted and she tried stretching to 30mm but was only able to get to about 28mm. Went home still no change to eating and drinking.

On the 16th of January I had another endoscopy stretch. Stomach was twisted again and was barely able to stretch it at all. I aspirated during the procedure. I woke up to them telling me to keep coughing to get it up. They observed me for 3hrs was on 4liters of oxygen at first then 2. I got up to pee with help my oxygen corrected itself. They said there was no need to keep me I only aspirated a tiny amount. They let me go home (2 hr drive home) I was freezing hole way hubby cranked up heat. Took temp when I got home and found I had a fever of 102.6 went to local er where they did xray and ct found I had developed pneumonia and I also had a pulmonary embolism. They felt I should go back to hospital where this happened and I stayed there for 6 days. 5 days of iv antibiotics and heparin for embolism then discharged on lovonox to continue for 6 months to a yr.

I still have no change so now its crunch time it has been 3 months since and cant eat or drink much at all. They want to do another stretch which I would need to come off the lovanox which is putting my life at risk. Not to mention I have had it done 3 times and it has not helped. Also if it doesnt work i would need to have the bypass revision which means 2 procedures putting me at risk 2 times) Surgeon says only other option is revision to bypass(unless he sees scar tissue and can fix. But i have to agree to bypass incase there is no scar tissue or it cant be fixed)

My family is up in arms it's hard either way. I dont want anymore procedures but I need to get stomach fixed and I need to get back to work. 3 months no pay we cant take this financially anymore. So for me I feel like they need to do the bypass and I hope for the best and have minimal complications. However the rest of family is worried I will have more complications than I have currently. Plus my sister had bypass and has had to have 15 different repairs(this makes them more worried)

I could really use some insight on this what would you do? What do you think I should do?

I develop stricture and torsion of the stomach also. I didn't fancy the idea of going in for a dilatation every 6 weeks. So i didn't even think of it as a viable option, nor did I let anyone persuade me into "giving it a try".

Nah.

I chose conversion and 1 week later had it done. Conversion to RNY resolved the issues completely.

I was given lovanox shots immediately after surgery so not sure why you have to stop them.

Good Luck 🌈

Edited by GreenTealael

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