pouch dilation

lbdunavant
on 11/16/10 1:40 pm
OK....I have messed this up I am afraid.  I went to the doctor 2 weeks ago about acid reflux and constant belching.  I hadn't had a fill in 1 year.  However, floro showed I had a pouch dilation.  They removed 1.1 cc of fluid.  I went on mostly liquids for 2 weeks.  Back today and same pouch dilation.  They replaced some of the fluid they extracted.  I am wondering though if my pouch is going to go down or if this is going to be a problem.  I realize I am the problem here, but I am wondering if it will ever go back to the correct size?  Any ideas?
bstecookie
on 11/16/10 1:54 pm - Minneapolis, MN
VSG on 10/23/12 with
Hi there,

Please don't beat yourself up. This could unfortunately be your fault but at the same time, there are many people that this has happened to that haven't done anything wrong.

It was my understanding that for pouch dilation they removed *all* the fluid for a period of time (like a month or longer?) and slowly and gradually start filling it again. Personally, I think it seems strange that they replaced some of the saline only after a couple of weeks even though your pouch is clearly still dilated?

Lastly, I've heard (not sure if this is true) that once someone has issues with a dilated pouch that it's always somewhat of a problem. I know for myself, my insurance will cover revisions to another band, sleeve, DS or RNY if my doctors can show that there has been some sort of "uncorrectable" issue (such as pouch dilation). You might want to ask your doctor or see what your insurance says about what the potential next step could be.

Hopefully a total unfill will resolve your acid reflux and let your esophagus rest and shrink back down.


Good luck and hang in there!

*Lap-Band (Feb 2009- October 2012) to VSG Revision  

    

Lynn B
on 11/16/10 3:23 pm
what is normally done for a dilation is a total unfill for 6 weeks with a repeat upper GI to see if the dilation has corrected. If not then revision surgery is usually prescribed. If the dilation has corrected then you can begin to refill the band slowly but you will be prone to dilation in the future.

I skipped the refill part and went right to the revision before to much damage was done and I had no other options. I would have the doc remove your fluid and wait at least 6 weeks if you want to keep your band.

Good luck!

Lynn B
Banded 9/12/2005 ~ Revision to VSG on 9/7/2010

Looking for a support group - near Bridgewater MA - we've got a great one! We meet the last Monday of the month @ 6:30.



M3lissa1971
on 11/16/10 7:26 pm

I'm going to ask a dumb question. What is a pouch dilation and how do you know when you have it? I'm a little worried now.

bstecookie
on 11/17/10 10:13 am - Minneapolis, MN
VSG on 10/23/12 with
Not a dumb question! And don't be worried- you're just fine! ;-)
Pouch dilation is when the upper pouch that is created by the band gets stretched out. It seems to be more of a "later" complication that usually results from eating too much and being too tight over long periods of time. I think the general symptoms are reflux and vomiting and possibly lack of restriction or sudden increase in restriction.

According to this website, a slip is considered something different than pouch dilation (although your band can slip and cause a larger pouch): There are two types of slippage; anterior and posterior. This refers to whether the front or back side of the stomach slips. There is something else called concentric pouch dilation but it is technically not the same as slippage. In this case the pouch just seems to be enlarged. Sometimes partial emptying of the Band may help with this. Slippage or prolapse is when the stomach slides up through the Band, making the pouch bigger. If this happens the Band usually becomes too tight, and patients experience symptoms of reflux (heartburn) as well as nausea and vomiting. This is because the amount of stomach being “squeezed” by the Band is increased, thereby obstructing the Band. There are several causes. Posterior slippage was more common when the Band was placed by the “perigastric” technique. With this technique the back side of the stomach was free to slide up through the Band. These days most surgeons use the “pars flaccida” technique, which was developed to prevent posterior slippage, and has more or less eliminated the incidence of this problem. Anterior slippage is when the front of the stomach slips up through the Band. We try to prevent this by suturing the stomach below the Band to the stomach above the Band, “locking” the Band in place in the right spot. In spite of this, slippage still occurs. It can happen because we haven't placed enough stitches, or they haven't been placed in the right place. Slippage can also occur if patients eat too much and vomit frequently."

www.laparoscopy.com/pleatman/Lapbandfaq.htm

*Lap-Band (Feb 2009- October 2012) to VSG Revision