Sleevehas a large bulge at end of pouch

on 11/29/17 3:20 pm

Okay so I am 3 and half years out from having the sleeve. I have gained 55 pounds back of the 110 I had lost. I went for a barium swallow today and they told me my sleeve had stretched and I had a bulge at the end of the sleeve. Has anyone had anything simulair?? What would cause the sleeve to bulge? It literally looked like a tennis ball on the images. I am looking at having a revision but not sure what my doctor will recommend.

on 11/29/17 7:54 pm

That is strange that your doctor did not explain what that buldge was when shown then X-rays.

Referral: June 2017
RNY with Dr. Neville in Ottawa: January 8th, 2018

on 11/30/17 10:00 pm - CA

I haven't had that problem, but have seen it a few times. It mostly comes from a poorly crafted sleeve, usually from a surgeon who is still fairly low on the learning curve of doing sleeves (a surgeon may be well experienced in bariatrics in general, but still a novice with a specific procedure, hence the usual advice to look for a surgeon with several hundred of the procedure of interest under their belt.) As I understand the specifics, doing a sleeve involves making a curved cut and suture line (following the minor curvature of the stomach) using straight tools; think of cutting a circle with a long set of shears - many small cuts rather than a few large ones. The result is often too much of the stretchy fundus left behind at the top or bottom of the stomach, and sometimes a stricture (narrowing) in the middle, which is what you are seeing with this bulge at the top.

The problem now is what to do about it. It usually can be corrected with a resleeve - if the surgeon has the experience to do that - fixing something is usually more difficult than doing it right the first time. The result of this is that the surgeon who is less confident in his sleeve skills will recommend revising to a bypass, as that is more within their comfort window, but this is akin to a mechanic replacing your entire engine because he doesn't know how to repair your leaking water pump.

It is this problem of revisions usually being more complex than basic, virgin surgeries that second (and often third,) opinions are a wise move. There are usually several ways to go about fixing a problem, and it is well to get the perspective of several experienced surgeons before making a decision. It is particularly important to seek out a surgeon who is well experienced with sleeves, preferably one who makes it their primary business (via VSG's, DS's and SIP/SADI's) rather than just a sideline along with bands and bypasses.

This site has a rather incomplete listing of surgeons who make the DS a focus of their practice, which typically means good sleeve experience as the sleeve is the basis of the DS. You can usually do a phone/email consult to get some insight into your problem without having to travel extensively if you don't have a suitable surgeon to consult locally.

Good luck in getting this resolved....

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


on 12/1/17 6:02 am

Thank you for the input. I still waiting to hear from the doctors office.