While the success rate of gastric bypass surgery is very good, complications from the weight loss surgery do occur. One of the rare complications is a gastrogastric fistula or leak in the newly reduced stomach pouch.
Recently a LivingAfterWLS reader named Margo suffered such a complication. She had surgery on July 11th. On August 18th she suffered a setback when a gastrogastric fistula was identified in the surgical area of her stomach. The fistula was identified with an upper gastrointestinal contrast study (UGI).
A fistula is an abnormal connection between an organ, vessel or intestine that results from trauma or surgery. In gastric bypass the separation of the gastric pouch from the main stomach decreases the incidence of fistula formation and stomal ulcer but does not eliminate it. Leakage of ingested food through the fistula may allow the small pouch to empty faster, leading to increased volume of meals and increased appetite. Patients stop losing weight or begin regaining weight. Surgical intervention may be necessary to correct the fistula.
In Margo’s case the leakage was causing vague symptoms such as nausea a couple of hours after eating. She said after two times of trying to vomit producing nothing but bile she knew her pouch was working. Margo added, “Luckily, after that I kept myself from retching, or I might have made it worse. I felt increasing but very vague pain in my stomach, but not necessarily in the area I knew my pouch resided. I went back to liquids only, and that did not help, either. This lead to the Upper GI.”
Fortunately she was early enough post-op on a limited liquid and soft food diet that she did not experience peritonitis, inflammation of the abdominal organs due to bacteria from the intestinal gastric contents.
After the fistula was identified Margo was put on IV feeding and her weight loss has stopped. She said, “I am hanging in, but just barely. Still glad I had WLS, though, and glad I discovered LivingAfterWLS.”
Nearly a month after identifying the fistula Margo is still on the IV feed but is able to add a few things to her diet. “I have had a second Upper GI and the fistula has improved a bit. My doctor now has me drinking liquids: when I get up to 48 oz of liquid, and 400 calories (of protein drink) for “several days” I can abandon the IV feeding and go back to square one. I’ll spend 2 weeks on a liquid diet, and then begin to add soft foods. I’ll have at least one or two more UGI’s.”
Margo says it hasn’t been easy to keep a positive spirit. “I want to add my positive spirit does not come naturally-I have been deeply depressed, but at least now I have something to aim for, and that has helped quite a bit.”
Take a minute to send some warm vibes her way, and leave her a comment here. I’m sure she’d love to know how much we are pulling for her. She said, “I appreciate your prayers and interest a lot, and am determined to muddle through this setback-and any others thrown my way-because I want to continue to lose weight so I can live!”
Kaye Bailey © 2005 - All Rights Reserved
http://www.livingafterwls.com
http://www.livingafterwls.blogspot.com
Tags: diet, fistula, gastric bypass, gastrogastric fistula, leak, morbid obesity, weight loss surgery, wlsdiet, fistula, gastric bypass, gastrogastric fistula, leak, morbid obesity, weight loss surgery, wlsShare This
As with any surgical procedure, proper preparation before gastric bypass surgery is extremely important to ensure the experience is not overly stressful. Assuming your doctor confirms that you are a valid candidate for a gastric bypass, the first thing you should do to prepare is to contact your insurance company to see if they cover weight loss surgery.
If the surgery qualifies for coverage, your insurance carrier may require both physical and psychological clearances as part of the gastric bypass preparation. They may accept information sent by your doctors or require you to see doctors of their choosing before they will approve the gastric bypass surgery. You also need to see what your financial responsibility will be, so you can make whatever preparations are necessary to pay for it.
Next, you will need to find a qualified hospital or surgical center and pre-register to undergo weight loss surgery. Pre-screening tests will need to be performed about a week prior to surgery.
The Day of the Procedure
Since your stomach must be completely empty to reduce the changes of vomiting during surgery, no food or drink is allowed after midnight the day before your surgery.
Usually, you check into the hospital or surgical center early the morning of your surgery to complete final paperwork and last minute tests. Then, you will be taken to a room where you will change into a surgical gown. Next, you will be taken to a pre-operating holding area where the anesthesiologist will discuss your medical history with you and answer any questions that you may have.
In the operating room, any other necessary preparations will be completed, and then the anesthesiology will start an IV for you. Now it’s time for the surgeons to work their magic.
What Happens During Surgery
Gastric bypass surgery is performed under general anesthesia, which means you will be asleep during the surgery. If you are having a laparoscopic procedure, the surgeon will make three to four small incisions in the outer abdomen wall and insert a micro-sized camera and different surgical instruments into your body. Your abdominal cavity will be filled with gas to inflate the space and make it easier for the surgeon to see what he or she is doing. If you are having the Roux-en-Y procedure performed, the surgeon will make a much larger incision, from your bellybutton to breastbone, through which to enter the abdominal cavity and perform the gastric bypass.
In both cases, the surgeon will create a small upper pouch in your stomach using a surgical stapler and reinforcing the staples with stitches. Then the surgeon will divide the small intestine and attach one end to the new stomach pouch, bypassing part of the digestive track so that food will pass directly from the new stomach pouch to the mid-point of the small intestine. The new, smaller stomach pouch prevents the patient from eating large amounts of food, and the bypass prevents the patient’s body from absorbing some of the calories in the food that is eaten.
After the surgery is finished, you will be taken to the recovery room where nurses will monitor your condition. As soon as you are ready, you will be sent home and scheduled for a follow-up with your surgeon two weeks later.
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This article provides an overview of health issues related to gastric bypass surgery and is not intended to replace the advice of a medical practitioner. Please consult your doctor prior to making any major medical decisions.
Craig Thompson, better known as “Big T,” has a reputation for doing things in a mighty big way. The former sumo wrestler who used to tip the scales at 400 pounds has since reinvented himself as a singer and bandleader. As one of the earliest to have Gastric Bypass Surgery, in 1997, Thompson now helps others at http://www.RenewedReflections.com
Tags: gastric banding, gastric bypass, gastric bypass surgery, lap band, weight loss surgerygastric banding, gastric bypass, gastric bypass surgery, lap band, weight loss surgeryShare This
LivingAfterWLS reader feedback indicates snacking is the single biggest problem for people after having gastric bypass - the problem being we snack on unhealthy items, we sabotage our weight loss or weight maintenance and we spiral back into the self-loathing that is so much an emotional part of morbid obesity.
None of us goes into surgery expecting to be the one “who lost all that weight and put it back on.” None of us goes into surgery expecting to become sneak eaters. We all believe we can beat obesity with our “tool” and we all expect to become healthier, more active, and yes dare I say more attractive and happier after WLS and massive weight loss.
Then why do we work so hard to defeat the system? To abuse the tool?
I spent time perusing the personal journal I’ve kept since weight loss surgery and I discovered some interesting things about myself and my snacking habits. See if these sound familiar to you:
- Five PM is a trigger snack time for me because I grew up having an after school snack (hungry or not) and when I walk in the door at night from my grown-up job I become a school kid and I want/need/crave my “after school snack.”
- When I opt for healthy high protein, low fat, low carbohydrate snacks I am remarkably satisfied and pleased with myself. These snacks include cottage cheese, a hard-cooked egg, deli turkey, sugar-free gelatin, beef jerky, almonds.
- Most often I opt for soft food snacks: crackers, trail mix RitzBitz, wheat toast with peanut butter, and worst of all, Nutter-Butter cookies. When I indulge in these snacks I am not satisfied, I feel sluggish and I become self-loathing. I risk dumping.
- Most of my snacking is done covertly - I purchase a single serve pack from the convenience store and eat it in private; never at my work desk, never in front of my family. This covert behavior is reminiscent of pre-WLS days and causes me to be disgusted with myself. “Who in the hell are you hiding from?” I asked myself in one entry.
- It never occurs to me to snack on carrots or apple slices or berries, oh no! I’ve convinced myself that roughage stuff will just tear up my tiny tummy. “Can’t have that”, I say shaking my head with much willpower and determination.
- Consistently my entries about snacking or self-loathing and remorseful filled with negative self talk like “ate mindlessly, AGAIN”, “nervous snacking today,” “carelessly ate a box of animal crackers, never tasted a bite and then got sick: I’m an idiot”, “I was shoving food in my face like a junkyard dog - how ugly that must have looked”, “I made stupid food choices today and then ate chocolate cake with frosting and dumped; it was like I was trying to punish myself and I did.”
- Consistently my entries about exercising are positive filled with words like “felt great” “could have ran another mile” “feel so strong” “tons of energy” “fantastic workout” “strong lungs feel phenomenal”. Yet I more consistently reach for the snack bag than I do my running shoes. Why can’t I get it through my thick head what a remarkable thing exercise is for me and that I really do enjoy it and I like myself when I move my body? Why is that such a hard concept to grasp? Why do I prefer to snack and engage in self-loathing?
- If I see the scale going up I panic and then I snack - almost as if I’m sending the message “This (weight loss) was too good to be true; better hurry-up and defeat myself.”
- Sometimes I snack just because it’s there - just like before surgery.
- I could not find a single entry that read “I was actually hungry today so I had a snack.” That tells me I never snack because I’m hungry. Honestly, I seldom feel hungry so why am I snacking?
Do these behaviors sound familiar to you? Are they some of the demons you are fighting these days? Snacking truly is bariatric purgatory because it derails weight loss and causes self-loathing. And worst of all, we do it to ourselves.
For ongoing dialog about snacking and strategies to beat the habit after gastric bypass click on www.livingafterwls.blogspot.com.
Kaye Bailey is a weight loss surgery success story having maintained her health and goal weight for 5+ years. An award winning journalist, she is the author and webmaster of http://www.livingafterwls.com and http://www.livingafterwls.blogspot.com
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Tags: gastric bypass, morbid obesity, regain weight, snacking, weight loss surgery, wlsgastric bypass, morbid obesity, regain weight, snacking, weight loss surgery, wlsShare This