Gastric pliation

My insurance approved my surgery.  I pay $108.18 then it's covered at 100%.  I think it's covered because they are fixing a hiatal hernia.  As far as resleeving goes, my Dr is insistent that he do the pliation instead of the resleeve.  He said that he cut 85% of my stomach out in '07 and yes it did stretch and I gained 80lbs.   But he believes the pliation is going to cause enough restriction and get me back on track.  So many if you have said such horrible things about the pliation that I am freaking out.  Who do I listen to?  My surgeon I've had a relationship with since '07 or the opinions on Obesity Help.   This is too much stress and has me doubting everything. 

It is my understanding that a plication procedure to tighten up a sleeve is actually a good safe procedure.....

A virgin plication on the other hand is not good because of so much closed off stomach is just left inside just hanging......and the thing I don't know is if you get the advantage of ghrelin reduction????

Do you know what size bougie was used in your '07 VSG ????

frisco

Bougie was a 40.  The largest one.  I think the ghrelin may not be a big deal.  I've just been emotional eating.  And I thought I was past that after 6 years.  I've literally gained all this weight since February.  I saw the pictures of my stomach.  It's not a huge stretched out pouch.  And I still have some restriction.  I appreciate the suggestions of other opinions, but I have a hard time finding a Dr I trust and I feel this way about current Dr.  He isn't experimenting on me, nor do I believe he would try to derail my weight loss with a so so surgery technique.  Just the negativity on here associated with it has me freaking out. Why do so many people have a problem with it?  Have they had the surgery with no success.  I do not want to have the DS or bypass.  I just want another chance with a tight sleeve to get back on track.  If any of you have read my previous posts you know that I've had a very rough year emotionally.  I gave up on exercise, eating right.  I just stopped living.  

I do appreciate the responses

I have a large sleeve too, so I can really relate to that part of your process.  I do not doubt you if you say that your stomach has stretched, so please do not be offended by my next observations about what I have noticed in my situation.

I can overeat.  Maybe I cannot put down a normal sized adult meal at once, however, if I am eating slider foods without a doubt I can overeat.  I have had days where I am well above 3,000 calories.  These are not days that I am proud of, and every so often I get a string of them.  In my case, it is always emotional eating that triggers it coupled with a period of time that my husband is also struggling.  (He lost a 100 pounds with me out of support, no surgery, but it is SO much harder for him to keep it off.)  During these stints I am SHOCKED at how much I eat, how drastically reduced my restriction feels- almost to the point that I have sincerely thought I stretched the stomach out.  But, I have thankfully been able to crawl back on the wagon after these stints.  It takes several days to detox, but after switching back to on plan eating, and using shakes more than what is typical for me (at least 3 a day) everything eventually swings back to my normal.  My restriction, assuming I am eating excellent choices 75% of the time, is excellent at 2 years out. 

I know you are years ahead of me, and I do completely see how regain to the magnitude you are experiencing is possible.  I think irregardless of the size sleeve one has, there is always the potential to eat around the sleeve.  I am absolutely certain that even with a significantly smaller size sleeve, when I have stints like what I described above the smaller sleeve would do nothing to prevent the abusive, self-destructive behavior of my overeating to that degree.  If I in the future am not able to pull myself out of that cycle, without a doubt I would have significant regain- and it would happen pretty fast if that cycle goes on for any length of time. 

So please excuse my ignorance on this subject, and if you don't feel like educating me on the topic I entirely understand.  What exactly is a plication, and what are the benefits in your situation?  What is it about this intervention that you  are struggling with if you trust your doctor?  By the way, I am very, very glad to read you trust your doctor.  I was not trying to insinuate in my earlier post that he is incompetent or anything- I just was posing a few questions for thought.  Like I mentioned, with my larger sleeve (larger than yours) and being over six feet tall and consequently a longer stomach than most women I can just really relate to your situation. 

I just want you to know that I am really pulling for you.  I wish I could be more helpful about your concerns with the plication, but if there is any other type of support that I may be of assistance with please do not hesitate to PM me.  I am proud of you for taking steps to stop the cycle of regain and work on attacking the issues you are experiencing.  Way to fight for your health!!

The pliation is where they fold your stomach in and staple/sew it shut to make the sleeve smaller.  They don't cut any of the excess stomach off. In my case it will give me that full restriction back.  Sadly I think for me that is what is necessary to get back on track.  A new start mentally and physically.  I asked the question about the procedure because I had never heard of it before my Dr said that's what we were going to do.  I researched it online and didn't see negative things about regain nor any unexpected risks/complications.  Then I remembered that I used to visit this forum often before and after surgery so I decided to see if there was any info about it on here.  All I read about was negative, people saying it was a horrible useless surgery and you will regain all your weight.  So even though I trust my Dr., the responses on here had me freaking out.  

I know now that regain is always lurking in the shadows and to be diligent abou****ching the slider foods in the future.  Thanks for your response and keep up the good work maintaining your sleeve.  

Hmmmm.  I truly have a hard time believing that stretching to that extent is the culprit.  Are you absolutely certain he did a proper sleeve on you?  If it were me I would be taking some pics for a second opinion.  At the very least, I would be seeking a second opinion in general.  I am not trying to imply that the option he is recommending is inappropriate- I don't know anything about it.  I just think given the situation another opinion would be a good idea.  

a second ... or even a third opinion ... is ALWAYS a good thing in my books!  ;)

For me,  I would not do.  You said you've gained from emotional eating.  Why not get some help and work on that?  You can get yourself in a program or do yourself.   Read books, listen to tapes on Compulsive/Mindless/Binge/Emotional eating go to support meetings (OA, WW, TOPS etc) Just take the time to work on yourself.   You said your stomach is not huge - you've seen the pictures.  You said you still have restriction! I would not possibly compromise my quality of life especially before I truly worked on my issues.

by all means get the hiatal hernia fixed.   That will relieve you of any symptoms you may be having like reflux?  

I wish you the very best and I hope that you do consider just changing your lifestyle, getting the help that you need.   Adjusting your diet.  What would happen if you follow the post op rules?

And me I am NOT one of those super successful sleevers in fact I never meet goal. I still have a lot of weight to lose but I work on it everyday.  Every single day I work on it!  I attend weekly meetings at Weigh****chers which I love.  We have a very special group going and I totally love it. I will always need to work on my food - I never had a super small sleeve nor any reactions to food that physically stopped me from eating so no disillusion here!  I did not experience the super WL window and now OMG i can eat because i have the stomach capacity and no adverse symptoms and i am gaining because I can eat over 1000 calories (really come on, what human being eats this little forever???).  It sucked at first but now I am glad I always Had to make the choices for myself and not have my stomach make the choice for me.  I'm so glad that I got a dose of reality immediately  - almost immediately post op.

Whatever you do, I wish you the fullest success possible.

L

Re-sleeving can be a very risky procedure. That is because your stomach already has that nice set of titanium staples running its entire length. It's very hard for a surgeon to know exactly where those staples are and to make a new staple line next to that old staple line. The risk of leak is much higher on a re-sleeve than with a new sleeve.

I have also heard that a plication is an excellent alternative to re-sleeving if the patient does not want conversion to RNY or DS. If your surgeon is someone whom you trust and have faith in his surgical skill set, I do not see why the plication would not be a good alternative.

I also think you might want to consider getting some help for the emotional aspect of your eating. I find that at two years out my only issues are emotional eating. I know how to eat, what to eat, when to eat, etc.... It's just that sometimes the old head games want to creep back - sometimes very sneakily. I can see how easily a "perfect storm" could arise and you could gain all that weight back so quickly. I think that the emotional aspect of eating is probably the biggest culprit in your weight gain. I could be mistaken and I don't mean to offend or criticize. Just something to consider.

Best of luck. I think I can safely say, we all want you to be successful!

Hi, I was sleeved in 2007 as well. I agree with Frisco. Plication just means taking some stitches in your existing stomach to reduce its capacity. This is the accepted procedure to tighten a sleeve. As Frisco says, plication doesn't work well with a virgin stomach because there is no ghrelin reduction, but it IS the way to tighten an existing one with moderate stretching. Since you are having a hiatal hernia repair, it makes sense to me to have him tighten it while he is in there. My sleeve has not stretched much because it was smaller to begin with, but when I had a large hiatal hernia repair last year, my surgeon, Dr. Cirangle, took a couple of stitches to tighten the the top part of the sleeve. Honestly, I don't notice any difference in capacity but I've also had no adverse symptoms. As others have mentioned (and you already know!), reducing the capacity will only be a small part of the battle as you will still be able to emotionally eat, eat the wrong things, graze, etc. etc. The hiatal hernia surgery coupled with a tightening may help kick start you to losing again--but you will have to do the hard work of eating the right things at the right time.

Best of luck!

Lizanne