Revision Again Tomorrow

Dec 08, 2010

My original surgery was in 1997. 
1) The surgeon removed the bottom of the pouch.  A recent endoscopy measured my pouch at 4 inches diameter and 3 inches long.  The operative notes indicate the stoma was designed to a "fingers breadth."  The recent endoscopy measured the stoma at 2 cm, which is a little more than 1 inch.  

The sleevers today get a pouch about 1 inch or less diameter.  For my revision, a narrow pouch will be the goal.  The stoma will be measured to a 38 fr bougie, which is slightly greater than half an inch.

2) My total small bowel measured at 700 cm, according to the operative notes.  The notes say that my alimentary was set at 350 cm, and the common channel at 100 cm.  

Using Dr. Hess' standards for DS, the 700 cm small bowel should be sectioned 40% or 275cm for total alimentary.  And the common channel should be 10% of total small bowel, or 75 cm.

So tomorrow, the surgeon will do these things.  Will give me the DS limb structure, but without a pyloric valve.  Unfortunately, changes to the limb lengths are not expected to produce much weight loss.  So says Dr. Keshishian.   The new lengths aren't much change from what I have.  It's too risky to bypass more so I am at the end of the line, so to speak. 

The biggest benefit from my revision tomorrow would seem to come from correcting pouch and stoma.  The original surgeon didn't believe in restriction, so that is why I've never had any.  This was compounded by a wide stoma, meaning that the small bowel served as a pouch.

I hate having to go for another surgery, but I hate my current state and have to try something.  Wish me luck.

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