Question:
The surgeon I am going to have does a double roll of staples on his pts but does not
use stitches also. (Of course) I AM NOT A SURGEON, ***but*** wouldn't it be better to use staples AND stitches? I am just concerned that in the old days some pts DID'NT pig out and their staples came out and they regained the weight. I know some people DID overeat and this is what caused their staples to come out, and the weight regain. I would like to know what you all think, and also did any of your surgeons JUST use double roll of staples instead of both? Will my surgery still be successfull if I follow all the proper guidelines? Thanks in advance for all answers. P.S. I asked him if a staple came out later (on our insides) after surgery, would this cause any damage to our insides and he said no, and looked at me like I was nuts. This didn't make sense to me either. Any comments would be great. — bufordslipstick (posted on September 19, 2003)
September 18, 2003
If he doesnt transect that is cut the stomach apart dividing with staples
AND sewing I would find a new surgeon.
Non transected you run a great risk of staple line disruptions, that can
cause weigfht regain, ulcers, and a long list of associated problems. Worse
yet you will need ANOTHER surgery to fix it. Better to do it right the
first time. Our bodies sometimes rejecyt the staples, its not just a
overeating issue.
— bob-haller
September 19, 2003
It sounds as if you are not confident in your surgeon. If this is the case,
maybe you should keep researching. I will try to explain my understanding
the best I can. Our stomach lining is a mucous membrane. When our stomachs
are just stapled, those mucous membranes are pressed together but will
NEVER heal together. Over time, there is the potential for the staples to
work themselves out, causing a staple line disruption. It does not matter
how many rows of staples are used, the stomach does not form scar tissue
and close itself off. I think surgically, it would be impossible to put
sutures along the staple line(s). There would be nothing to sew together,
because basically you are just partitioning off the stomach. With a
transected stomach the stomach is first stapled (making a partition) and
then cut apart between the staple lines. My surgeon then uses sutures and
oversews the edges of the old stomach and also the pouch. Those edges are
not just mucous membranes and are able to form scar tissue and heal closed.
I would definitely recommend transection. Many surgeons will boast that
they use "x" number of rows of staples. However, this is not a
guarantee of SLD prevention. For further info about a member who had an
SLD, see Marilyn Childers profile. Good Luck! Shelley
— Shelley.
September 19, 2003
It is incorrect to assume that staple line disruptions occur because a
patient "pigs out". That's flat-out wrong. Sometimes, the body
rejects foreign objects (such as staples) when it is healing up. This is
not the only surgical procedure out there where the body's rejection of
foreign objects (here, staples) is a problem in a minority of patients (it
happens with other types of surgeries, as well). You should know that
there are numerous examples on this site of patients who developed a staple
line disruption who gained back *no* weight before it was diagnosed, or
gained back very little (so much for the pig-out theory), and numerous
examples of folks gaining back quite a bit of weight over time because of
grazing their way around an otherwise still intact staple line (even after
surgery, most of us still have to fight against bad eating habits). If
your doc suggested that staple line disruptions only happen to
"bad" (read: overeating) patients, you need to know that is
simply not true. There is no guarantee, short of transsection, that you
won't be in the minority of patients whose bodies reject staples over time.
But even with a transsection, you can develop a fistula, a condition where
the pouch and stomach, though surgically cut apart and sewn up separately,
still manage to rejoin one another. These are relatively rare conditions,
but there are no guarantees.
— Suzy C.
September 19, 2003
Hi, yes you did hit a sore spot with me too! lol! Staples do not come
lose because of overeating. I had staple line disruption with my first rny
and I had eight (8) rows of staples! But I was not transected. That is
what causes staples to come lose. If the pouch is formed by stapling and
not physically separating it from the old stomach, a good scar tissue
"seal" won't form. The staples come lose because the two mucuosy
edges of the stomach when it is divided simply by staples will not seal
itself off. There is still a connection to the old stomach. It doesn't
matter how many rows of staples you have. Why doesn't your surgeon
transect? I would never have WLS without transection. I was revised to a
transected pouch and now I am confident it is a permanent pouch. With
stapling alone, the staples could come lose within the first year or first
week or first decade. You just don't have the assurance that it will stay
a small pouch without transection. Ask your surgeon to transect your
pouch. Most surgeons do transect.
— Mylou52
September 19, 2003
I also am interpreting that your surgeon does not transect. If this is the
case I would be very leary of going with him. It's just pretty much
accepted that transecting is the best way to go for prevention of future
staple line failures. My surgeon does transect, staples everything and
then oversews all the staples to give us the best chance of not leakes.
But even at that it does sometimes happen, but not much. Too me it is
something simple that can assure you won't need a future surgery for that
problem. Think about getting a 2nd opinion.
— zoedogcbr
September 19, 2003
No, we did not pig out to lose our staple lines. I love the myths the
medicals use to explain their failures! Grrr. Someone at the ASBS
conference explained to me that in a non-transected lower stomach, the
digestive juice can build up. Normally they ebb & flow with the intake,
output of food. But since no food arrives, the gastric cocktail may not
release right on schedule. Hence, it is believed that backpressure from the
BIG stomach causes the staple line to disrupt FROM THE BOTTOM UP. If you
lose staples here 'n there over the years, you end up regaining your wt.
You don't die, but you might wish to. Having had 2 of these surgeries, I
certainly stand united with Marilyn in saying: DON'T DO IT!!!!!
— vitalady
September 19, 2003
Thanks for all the info. I will be calling Dr Garrs office on Mon to see if
they do the transection or not. I will show him all of this info when I go
in for next appt. He is/was?? head of surgery in a local hospital here, so
feel that he is a very competent WLS Doc. I'm glad I happened to think of
this question. This IS very valuable info. I certainly don't want to have
to have this surgery done again because of staples coming loose, when could
have been avoided the 1st time.
— bufordslipstick
September 19, 2003
P.S. I didn't write this exactly right in my original question. What I
meant to say is "We all have heard people say that former WLS pts
overate and (busted their staples out) had SLD. And most of these are
STUPID people that don't take the time or get the correct info on WLS and
think we're taking the easy way out. These are the same ones telling me now
pre-op, "Don't gain all your weight back-KEEP IT OFF!!!" Yeah,
riiiiiiiight.
— bufordslipstick
September 20, 2003
You didn't say if he is going to transect your stomach or not. If he doen't
transect you run a greater risk of sld, but if he does transect over time
the stomach will actualy grow over the staple line and you won't have to
worry about disruption. That's why the first few weeks are so critical with
following your doc's instructions. The main reason doc's now use staples
instead of sutures is that it is quicker. Not better or worse, just
quicker. Besides. After you pig out once, you won't want to do it again. It
is the most misrable, painful and uncomfortable feeling in the world (I've
only overeaten one. That's all it took to teach me that lesson). Overeating
once or twice (just a little) won't cause disrutption. You have to work
hard to cause sld.Good luck and God bless!! 19 weeks out, down 70 lbs
— mellyhudel
September 20, 2003
Melody, sorry but once again....overeating (if you could stand the pain)
does NOT cause SLD. SLD is a mechanical failure of not being transected.
Period.
— Mylou52
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