Revision concern (further stomach downsizing)

 Next week I have an appointment for what I believe to be an assessment appointment with Dr. Hong at St. Joe's as I'm pursuing a DS revision (VSG done October 2009).

Surgeon of choice is Dr. Gagner in Montreal.  I sent him an email this afternoon with my surgical report, which I received from the Cleveland Clinic yesterday.  Was surprised to even get a response a few hours after emailing it to him.

Anyway, he said that the method they used for the VSG likely means I have a larger stomach than whatever method he or others may use and that a barium GI x-ray would likely show this.  He said if that were the case the stomach would likely have to be downsized again.

My biggest concern and the cause of any anxiety I had surrounding my surgery was post-op and the potential for leaks and healing.  Was not concerned whatsoever with prior to the surgery.

Now I'm wondering if I were to say I didn't want the stomach downsized yet again that I would then be seen as a difficult patient?  

I realize the point of the DS (or any WLS really) is to be restrictive, and I certainly do feel the restriction is sufficient as is.  

I don't know, perhaps I'm completely wrong on my thinking of what's good for me.

may i ask why you're seeking a revision?

 Hi Monica:

The surgical approach for me was always going to be a two stage approach given my extreme weight and BMI (750lbs, and a mid-90s BMI).  Day of surgery in October 2009 I was 700lbs and a 89.6 BMI accroding to my surgical report.

A previous surgeon at St. Joe's said she would advocate for a two-stage DS if that is what  I wanted, however the MOH/OHIP then went and made a deal with the Cleveland Clinic where a VSG followed by an RNY revision was proposed.  I agreed to the first stage, but stated I would continue to seek a revision to a DS when it came time.

I've lost over 200lbs with the VSG, and around 280lbs overall from my heaviest.  150-200lbs was the mark the surgeon figured I'd be fortunate to hit.

So it has been a week shy of 21 months since my VSG thus the golden period has been long gone for a while.  

I just really do not want to have to deal with the stomach being cut up further as I have finally been rid of the terrible acid reflux/heartburn for the past few months.  And I've already mentioned my concerns with having to deal with worrying about the healing process along the seam line.

I feel it is a valid concern, but others may not.

 Hi Jeff,    
To put it simply I'd go with whatever Dr. G. says to do!  He is one of the best in the world for WLS,  we're so lucky to have him operating in Canada, people travel from around the world to have him.

How much can you eat now?  If your weight loss has slowed or even stopped then your stomach has likely become a normal size again, so to get the restriction and malabsorption you need your stomach smaller.  An upper GI will show that,  remember if you go for one drink lots!!!! of water after or the barium turns into a 'brick'.

I wouldn't be too concerned about what he'll do until you get to see him.  I hope that happens soon!!

Thank goodness OHIP is finally getting their act together and seeing the benefit of DS, gotta feeling they'll be paying for some revisions in the future!


jan

Jan, you don't see Dr. Gagner before surgery, all pre-op is done at the centres in Ontario.

I think your concerns are perfectly valid. The first step is to do some testing to determine the size of the stomach and then consult with Dr. Hong and Dr. Gagner. Based on the tests, they will give you their professional opinion about the best way to proceed, and then you can ask about alternatives and compromises.
Do keep in mind that leaks are very, very rare and Dr. Gagner is literally the top surgeon on the continent for the DS. I also understand that he believes in considering the patient's preferences for surgery (he has helped many people advocate for DS from OHIP). I am sure you will be able to come to an arrangment that everyone can support. Good luck and keep us updated!

I'm begging him to downsize my stomach and he won't respond either way : (
I always understood that the VSG stomach was smaller than the DS stomach because thats the main (only) tool - malabsorption and DSers need room to get all of their protein.
Request what you feel is right, especially after getting the upper GI results.

 I think you have a valid concern.  There is no way that your stomach has stretched back to normal size in fact vsg stomach's barely stretch.  You're a big guy and even thin you will need to consume enough calories to keep you strong and healthy.

I would go with my "gut" instincts if I were you.

 I was out yesterday (and will be today and tomorrow...Blue Jays games), however I saw I had received a few responses and I was concerned what might be said.  

I appreciate all the supportive responses!  Obviously I'd make a "gut" decision based on the GI x-ray results.

As for my stomach now I would not say that I can eat a ton.  The weight has slowed down, and I am still losing, but I'm also noticing more muscle mass as well as I am much more mobile these days. 

I'll take it a day at a time and see what is suggested.