Really concerned about what might have happened during my surgery

Hello. I am praying for some responses. I had a Lap Band for 12 years and when it failed I decided to have a revision to a sleeve. Please know my surgeon is someone I have trusted for many years and have a great Dr. Patient relationship with. After the surgery though, I was not feeling what I felt I was supposed to feel especially in regards to hunger. I got my operative reports from the hospital and they say that my "omentum" was removed and a partial gastrectomy. If you look up partial gastrectomy it is different than a vertical sleeve gastrectomy. I am very concerned and I also feel very bad questioning my Dr about this but, I think I have to or do you think it's possible that a Dr. called a sleeve a "partial gastrectomy"? if it were you and your body, what would you do? I realize most people don't get their surgery reports and question their Dr's. I see him tomorrow. I never expected such poor results with this either. I was much more successful with my lapband. Now I have reflux and no weight loss. He had me do a gastric emptying study today and that was normal but we will discuss results tomorrow. tell me, would you ask about the wording "partial gastrectomy" if you google it, it's not a sleeve gastrectomy. I'm so sad, perplexed and hoping to hear back from you guys.

Absolutely ask! Don't be afraid of what you have read, you need to share it with him.

There's no harm in asking or in sharing your concerns about what you expected to feel post-op versus what you are feeling.

You paid your surgeon to provide you with a service that entailed you undergoing major surgery. You have every right to ask as many questions as you have to in order to ensure the service/surgery you requested and paid for is what you got. He works for you, not the other way around.

I think you should ask - I also think it's completely plausible that a vertical sleeve gastrectomy would be called a partial gastrectomy because it IS a partial removal of the stomach which is literally what those words mean.

I also would as about the removal of the omentum, since that seems strange to me. The greater omentum has lymph function and also physical protective function.. but there's also the lesser omentum. I'd want to find out what that meant.

Reflux can be an issue with VSG - are you taking a PPI such as prilosec or nexium? If not, you should be. It might be temporary or it might be GERD that requires a revision to RNY.

Hunger is also normal after the VSG - your body has other places to make gherlin. But hunger is also often due to acid and a PPI will resolve it.

As for the weight loss - what, exactly, are you eating every day? Give us an example of a day's meals. How much are you drinking? Are you logging everything you put into your mouth with something like MyFitnessPal? If not, you need to start.

I am on a ppi. I'm also on over the counter gsmotidine. I will ask about the omentum. So the hunger can't be that. No. I'm not logging or journaling. I'm going to toally own my part of this failure, I just never did that with my band and this had been a transition I did not expect. For 22 years my band physically stopped me and I just didn't even attempt certain foods that I'm eating now. Just because I can doesn't mean I should. So I went back and looked at the report from hospital it just says omentum was sent for pathology doesn't say greater or lesser. Also it says partial stomach in the pathology report which is what is taken off, partial stomach .. in the hospital he said my stomach was as big as a thumb ! It sure doesn't feel that way... do you know what test would show me all I need to know about my stomach size, shape etc? Thank you so much for responding

The hunger can still be acid - you might need a different/stronger PPI or similar.

You need to start logging everything you put into your mouth so that you know what you're eating. If you're not losing weight it's probably because you're eating more calories than you expend and the only way to know that is to track. MyFitnessPal is free and easy to use. Sadly the surgery isn't magic, we still have to eat the correct diet for the rest of our lives.

Ask your surgeon about the omentum thing. I'd be super curious.

The sleeve gastrectomy does remove part of your stomach so, is technically, a partial gastrectomy. Again, ask your surgeon.

Any test that shows soft tissue would show your stomach. CT scan and ultrasound come immediately to mind. X-ray with barium swallow would work too.

But I think you know what you need to do - track your food, prioritize dense proteins, skip processed and refined carbs, drink lots of calorie-free liquids.

First of all, I tell everyone to always get your surgical report and to ask questions. Every patient is entitled to getting their surgical report. You have every right to question someone who is removing major organs from your body! Just because someone is a medical professional doesn't mean we are immune to mistakes! I tell my clients to question me all the time or to let me know if something doesn't work, because if I am trying to help people, it's blatantly stupid to not listen to them! They are the experts on themselves after all.

At any rate, bring a list of questions to the doctor and demand answers.

1. Why was the omentum removed? What size was removed?
2. Please give me the dimensions of the remaining gastrectomy. How did you form the gastrectomy? How is it shaped?
3. Do I still retain my pyloric valve?
4. What is the cause for my reflux?
5. Why am I less successful with the gastrectomy, when typically sleeve surgeries have better outcomes than the lapband?
6. Etc...

It is worth obtaining a second opinion regardless, I feel, as this should have been explained to you the day of surgery if unplanned procedures were done.

Hi! Thank you so much for your response! What is the pyloric valve? So I went back and looked at the operative report and it's a pathology report. Dimensions of what he removed are in there and it says in the pathology report

a. Omentum

b. Partial stomach and the size was approx 10x8x8 I could be wrong it's not open in fromt of me.

Sp maybe it was a sleeve and removal is described as partial stomach ? Could that be? At any rate, what kind of test would need to be done to see the stomach size, shape etc. ? Is it not normal to remove omentum ?

What can he do about the reflux now I can't have a third surgery to a bypass now and the antacids causing all sorts of iron deficiencies

A

This makes some sense now, as the pathologist doesn't necessarily know, or care, what procedure was done or why, just that he has these different tissues to examine. So, a piece of stomach would be from a partial gastrectomy, whether from a sleeve or from a resection for some other reason. There probably isn't any particular test that concerns the size or shape of the sample, rather he would be looking for any abnormalities in the sample - ulcers, polyps, displasia, h. pylori infection, etc. Pretty much anything that they take out of your body is going to be sent to a pathologist for examination.

The omentum is in close proximity, or contact with the stomach, so I would guess that it would not be unreasonable that some of it got removed along with the stomach, or possibly they just took a sample for biopsy purposes.