Endo stitch for stoma repair

[Ms M]

Has any Gastric bypass patient had the endo stitch procedure done to reduce an enlarged stoma and what was the result/outcome? did the procedure work or has it failed like that of the rose, stomaphyx and the sclerotherapy proceedure?

Any responders would be greatly appreciated

 

[Charris]

I've never heard of an endo stitch. But that doesn't mean anything. I just want to say hello and welcome. I'm sure one of the long time vets will chime in and know about it.

Edited Auto correct

 

[southernlady]

Welcome, @Ms M
I can't answer either.

 

[DianaCox]

I haven't heard of ANY of those surgical fixes to work long-term. Weight loss in the immediate post-op period is from the diet they put you on, and it all comes back, because it doesn't fix the REAL problem, which is your metabolism. The DS is the only functional fix I know of.

 

[Larra]

These procedures are all similar (stitches and/or staples placed via endoscopy) and none of them has been shown to work. They are considered experimental and not covered by any insurance policy that I've ever seen (and @DianaCox and I have seen a lot of policies!), and I don't think that will change because they are so ineffective. So, except for a few "lucky" people who were included in clinical studies a few years ago, patients pay for these ineffective procedures, usually at about $10,000, and get nothing but disappointment for their hard earned money.
Most of the docs doing these ineffective (have I said that enough?) procedures put their patients on a liquid diet for a few weeks afterwards, so people do lose some weight from the liquid diet, after that, the weight loss stops. All these procedures will accomplish is to lighten your wallet and possibly make any real revision more difficult by creating more scar tissue for a future surgeon to deal with.
Save your money. Save some more, and see if you can accumulate enough to get a revision to a DS, which is the only revision that is going to make a lasting difference. If you have health insurance, get a copy of your EOC (evidence of coverage, NOT just a summary of benefits) and see if you have any coverage for revisions. Maybe you are stuck with what you have, IDK, but at the very least don't waste your money.

 

[Ms M]

Hi Diana, Larra and all. My story is a very complicated one and Diana i do remember you from a previous DS Group that was started a while back by Melodie who was the site and forum owner at the time, back then i was known as babyface and my original surgeon for the DS was Prof Simon Woods in Melbourne Australia. Initially i was a lap band patient but due to slippage three times i was converted to DS Duodenal switch then due to the surgeon severing the vagus nerve and due to the DS sleeve narrowing in the middle and shaped like an hour glass which ended up giving me two pouches so to speak it had to be revised into a sort of RNY type surgery due to having issues with gastroparesis due to the severed vagus nerve and also bile reflux so now my anatomy is technically a gastrectomy whereby i don't really have a stomach as such nor a real pouch. I have been fine and had no issues for the first couple of years but am now experiencing the bile reflux issues again. my current surgeon did a gastroscopy on me two weeks ago and said that my stoma has stretched to 3 or 4 center-meters and that i needed to have the endo stitch procedure to reduce the stoma size back down to one center-meter now the only problem is that he can not do the procedure now as he is waiting for the equipment to arrive from the USA. personally i cannot see it working as i believe that with gastroparesis because there is no muscle function due to no vegus nerve the food pushes its-self down the food pipe and into the intestines so even if i had the procedure done the stitches wont hold and therefore am concerned as to what will happen down the track (a long intestine with no pouch, sleeve and or stomach is a very long food pipe) the things we do to try to gain our heath back by trying to lose weight doesn't always work out i do understand and am aware of this the thing i don't understand is why do we always have to suffer in the process any way thank to all for responding much appreciated and thank you all once again.

Kind Regards M

 

[Larra]

@Ms M I am so sorry you have been through so much! It's sad that a simple desire to improve your health can lead to so much heartache.

I really don't know what to suggest. It does seem strange to me that you would have been diagnosed with bile reflux with a DS, because that would be almost impossible. With a DS, the duodenum is completely divided just a bit past the pylorus (the valve at the end of the stomach) and the new connection is far downstream. Bile would have to travel upstream quite a distance to get to your sleeve and from there to the esophagus, which is incredibly unlikely, if not outright impossible.
Even with a true gastric bypass, there is a RNY type connection of the small intestine to the pouch, or whatever part of the stomach it was connected to in your case, making bile reflux very unlikely in this case as well.
I have no idea how having gastroparesis would affect the function of your stoma either at its present size or a smaller size. I also don't know how having a narrower stoma would fix bile reflux, as bile is a very thin (usually) liquid and can easily flow through a narrow passage. but then, I also don't understand why you would have bile reflux to start with.
On the positive side, it sounds like you don't have to deal with the insurance issues we face in the USA. Apparently if your surgeon thinks you need this procedure, he can get it done. It sure isn't like that here! But, how he thinks it's going to benefit you is a mystery to me. I hope he finds a way to help you.

 

[DianaCox]

Since all she has left is a pouch anyway, I wonder if converting her intestines to a median-length RNY, while completely re-doing the stoma (in other words, a real surgery, not an endoscopic procedure) would be the better way to go? It would prevent the bile reflux by making the anastomosis of the biliopancreatic limb far enough down the alimentary limb that bile reflux is not possible?

 

[Ms M]

@Ms M I am so sorry you have been through so much! It's sad that a simple desire to improve your health can lead to so much heartache.

I really don't know what to suggest. It does seem strange to me that you would have been diagnosed with bile reflux with a DS, because that would be almost impossible. With a DS, the duodenum is completely divided just a bit past the pylorus (the valve at the end of the stomach) and the new connection is far downstream. Bile would have to travel upstream quite a distance to get to your sleeve and from there to the esophagus, which is incredibly unlikely, if not outright impossible.
Even with a true gastric bypass, there is a RNY type connection of the small intestine to the pouch, or whatever part of the stomach it was connected to in your case, making bile reflux very unlikely in this case as well.
I have no idea how having gastroparesis would affect the function of your stoma either at its present size or a smaller size. I also don't know how having a narrower stoma would fix bile reflux, as bile is a very thin (usually) liquid and can easily flow through a narrow passage. but then, I also don't understand why you would have bile reflux to start with.
On the positive side, it sounds like you don't have to deal with the insurance issues we face in the USA. Apparently if your surgeon thinks you need this procedure, he can get it done. It sure isn't like that here! But, how he thinks it's going to benefit you is a mystery to me. I hope he finds a way to help you.

Hi Larra, I too couldn't understand why or how i had bile reflux but i did and it showed up in the barrium swallow test that was done to show and to detect gastroparesis. when the surgeon severed the vagus nerve it not only affected the actual stomach portion or what ever they call it (gastrectomy) but it also affected the intestines as well so the food does not flow through like its supposed to and get digested it sort of pushes itself along the way. i have to be really very strict with what i eat and drink and make sure that there isn't any fat in my diet as fat slows down the digestion process further.

Thank you kindly for replying.

I tried to attach links of gastroparesis and intestinal paralysis but the system would not allow me to.

 

[Ms M]

Since all she has left is a pouch anyway, I wonder if converting her intestines to a median-length RNY, while completely re-doing the stoma (in other words, a real surgery, not an endoscopic procedure) would be the better way to go? It would prevent the bile reflux by making the anastomosis of the biliopancreatic limb far enough down the alimentary limb that bile reflux is not possible?

Diana, Is that sort of like a distal RNY?

 

[DSRIGGS]

Hi Larra, I too couldn't understand why or how i had bile reflux but i did and it showed up in the barrium swallow test that was done to show and to detect gastroparesis. when the surgeon severed the vagus nerve it not only affected the actual stomach portion or what ever they call it (gastrectomy) but it also affected the intestines as well so the food does not flow through like its supposed to and get digested it sort of pushes itself along the way. i have to be really very strict with what i eat and drink and make sure that there isn't any fat in my diet as fat slows down the digestion process further.

Thank you kindly for replying.

I tried to attach links of gastroparesis and intestinal paralysis but the system would not allow me to.

Hi and sorry for your predicament. My 22 year old son had severe gastroparesis due to his vagus nerve being severed during a repair to his nissen fundoplication and the asshat Dr never bother to tell us about it. We had to figure it out on our own. Cameron was lucky in that he has a regular stomach so Dr Keshishian was able to put in a Rouxen Y Drain off the greater curvature of his stomach so food that doesn't exit via his pyloric valve basically gravity feeds into his small intestine. It greatly improved his life and frankly changed his outlook on life because you know how miserable you feel with severe gastoparesis.

BTW he also had bile reflux after having his gallbladder removed at 17.

I wish you had been able to have the option of the rouxen y drain, but obviously without a full stomach that wasn't possible.

Are you on any motility drug for your intestinal paralysis? I would think that would help to get things moving that way?

 

[Ms M]

Hi and sorry for your predicament. My 22 year old son had severe gastroparesis due to his vagus nerve being severed during a repair to his nissen fundoplication and the asshat Dr never bother to tell us about it. We had to figure it out on our own. Cameron was lucky in that he has a regular stomach so Dr Keshishian was able to put in a Rouxen Y Drain off the greater curvature of his stomach so food that doesn't exit via his pyloric valve basically gravity feeds into his small intestine. It greatly improved his life and frankly changed his outlook on life because you know how miserable you feel with severe gastoparesis.

BTW he also had bile reflux after having his gallbladder removed at 17.

I wish you had been able to have the option of the rouxen y drain, but obviously without a full stomach that wasn't possible.

Are you on any motility drug for your intestinal paralysis? I would think that would help to get things moving that way?

Hi DSRIGGS,

Thank you so much for your response and i'm so very happy and glad that your son is doing well with his gastroparesis, it's a horrible thing to live with.

The Dr has put me on motilium (domperidone) for my GP.

Much Regards, M

 

[DSRIGGS]

Hi DSRIGGS,

Thank you so much for your response and i'm so very happy and glad that your son is doing well with his gastroparesis, it's a horrible thing to live with.

The Dr has put me on motilium (domperidone) for my GP.

Much Regards, M

Thanks M. That stuff is almost impossible to get in the staes....hope you get relief for your issue.

I would suggest emailing Dr k and explaining your situation and asking if he has any ideas your tea Melbourne can try. He loves to help even if they aren't his patients.

 

[southernlady]

I tried to attach links of gastroparesis and intestinal paralysis but the system would not allow me to.

Sorry about that but the system is set that way to avoid spammers who usually post links in their first few posts. We set it to require 10 and more than 24 hours since registration. Well, it's been 24 hours but you still need a few more posts under your belt.

 

[Larra]

@DianaCox I'm just guessing here, but my guess is that, with so many prior abdominal surgeries and with so many surgeries on the stomach in particular, the surgeon is hoping to avoid the risks associated with what is likely terrible adhesions. Doing something endoscopically would be much less risky. Unfortunately, it is also much less likely to be effective.