RNY pouch is 4cc instead of the regular 30cc...what could I expect?

[BookWormMamma]

Hello everyone,
I am taking my pre-op tests to the doctor's tomorrow (for a possible revision) and today I got the actual results of the upper GI...turns out my pouch has 4cc/ml capacity, which means it is REALLY tiny...and I feel like such a failure! How can I have gained 50% of the weight I lost if I basically have no stomach??...what can I expect from the doctor tomorrow? What would you do if you were in my shoes?

Thanks.

Have a nice Wednesday

 

[Larra]

I've never heard of a pouch that small. I wonder if them meant 40 cc and not 4. Could be a typo.
But setting that aside, the size of the stoma is often more important than the size of the pouch. If the stoma is too large, or has become too large over time, food just falls right out of the pouch into the small intestine, leaving a near constantly empty pouch.
But really, if you are able to eat more than 2 bites at a time, I just don't see how your pouch could be 4 cc.

 

[DSRIGGS]

Wouldn't 4cc be like about ten drops of water? I am in the Larra typo camp.

By the way you didn't fail the surgery, the surgery failed you. There is a reason why we are so pro DS on this board. It simply works and the other WLS just don't have the DS' level of longterm EWL success. You will als I note that there are numerous RnY GBP to DS revisonistas on this board.

Who are you seeing to discuss a revision? There are not but a handful of qualified RnY to DS revision Dr's in the world. Dr Ara Keshishian I'm SoCal, Dr Rabkin in the Bay area, Dr Ayoola in Texas, Greenbaum in Jersey and I think Boyce in TN maybe now.

I am a Dr K revision patient for another reason. My virgin DS was not done properly so I absorbed way too little and became very malnourished so Dr K lengthened my Alimentary Limb to fix me. I am VERY BIASED bit there is no better DS surgeon or human being in this world than Ara. His follow up and care is like nothing you have ever seen or ever will again. He and I have traded probably 500 emails the last two years and the first time I reached out to him about my son who had other intestinal issues..well I Sen an email at 6:30 or 7 am CT thinking his staff would get back to me with in a week. I went out to my kitchen to get another cup of coffee and saw I missed a call from californis. I called back and this guy who had no idea who I was talked to me for 45 minutes. He would not take my insurance or debit card number to bill me. His response, nonsense, I like what I do. He didn't even try to get us to come to him to do Cameron's surgery because he said a good general surgeon here in IL could do it. 2 months later we were in Glendale and he pretty much gave my 20 year old at the time son's life back. He went in to do one thing and fixed two others. I love the man like a brother for what he did for my son and for me. In fact I will be going back to Glendale at the end of the month for a surgery to fix a major problem with my colon.


So there is my plug for Dr K who is widely recognized as the best in the field.

Best wishes to you and I hope that you can get this figured out and taken care of quickly.


BTW, welcome!

Where are you from and who did your RnY and when?

 

[bearmom]

I've seen one report that referred to both cc, and oz! I'm guessing Laura hit the nail on the head, but also wondering if you've heard two different types of measurement. And yah, the stoma has more to do with the RNY's regain rate than anything else.

 

[BookWormMamma]

I am in Chile, so I don't have the options you guys have...anyway, I am going to the doctor's today. I read somewhere else that back in the late 2000's, it was normal for doctors to leave a tini tiny pouch...so, we'll see. The doctor today will read that upper GI results, and he himself did the endoscopy, so he will have all the information, and we'll see.
After that, I will have the whole medical insurance ordeal...I just asked today, informally, and they said that I need a REALLY GOOD report from the doctor, and that, the fact that this surgery would be to solve a health problem (anemia) it might be a little less complicated to get the OK from the insurance company.

THanks a lot for takingt he time to answer
Have a nice day!

 

[Larra]

@BookWormMamma there is such a thing as a "micropouch" that some surgeons did, but even that would stretch out over time. Let us know what the doc says.

 

[-Flo-]

If your pouch was really 4cc you would have trouble with getting enough water in. It's a typo.

 

[Spiky Bugger]

I am in Chile, so I don't have the options you guys have...anyway, I am going to the doctor's today. I read somewhere else that back in the late 2000's, it was normal for doctors to leave a tini tiny pouch...so, we'll see. The doctor today will read that upper GI results, and he himself did the endoscopy, so he will have all the information, and we'll see.
After that, I will have the whole medical insurance ordeal...I just asked today, informally, and they said that I need a REALLY GOOD report from the doctor, and that, the fact that this surgery would be to solve a health problem (anemia) it might be a little less complicated to get the OK from the insurance company.

THanks a lot for takingt he time to answer
Have a nice day!

But 4 cc = a little more than 3/4 of a teaspoon. If you are not severely dehydrated, there may just be a missing zeo.

 

[DSRIGGS]

And even 30 cc would be stupid tiny as that right arounf 1 fluid ounce

 

[BookWormMamma]

Hello everyone,
So, I went to the doctor yesterday. The pouch is 40cc, not 4 cc; but the anastomosis is twice the original size, which means that I eat, and food just slides down, and I don't absorve much, which explains the anemia and vitamin deficit, which is all worsen by my poor food choice - which is just an elegant way to say that I eat just non-nutritious crap.
Anyway, he did mentioned the possibility of going to a 'distal' RNY, or just moving the bypass lower, but that means even less absortion of nutrients, so he ruled it out; then, they could make the anastomosis smaller, via laparoscopy, but he said the results are not the best; so, if we're going to surgery, he confirmed the conversion to a sleeve, since the RNY did not work for me, and I have this 'side effect' of anemia and vitamin deficit. BUT, he told me to first, try to work things out in a non-surgical way, so he told me to go to the nutriologist, and mentioned a new medication that was initially used with diabetics and now FDA approved it for obesity; it is ashot, it is a hormone, but I just can't remember the name.
I did mention the DS, and he told me he has never done it, it is not done in Chile (period) and he is not going to use me as a guinea pig, so, that is totally out of the question. He told me to give this option a 3 month period, and if it doesn't work, then we would go for the surgical solution.

Actually, I agree with him, and I respect him a lot for considering my options and health first, instead of trying to get me into the OR right away (and the money that means!) So, even though I did thought about getting a second opinion, I truly think it is worth to give it a shot.

So that's that. He didn't want to answer when I asked him if this means that, had the original doctor made the pouch less small, the outcome would have been different, which again, speaks pretty well of him.

Do you know what the name of this hormone shot is? He mentioned that people normally lose 2 pounds a month, but sometimes patients lose up to 4 or 6 a month, which would work wonderfully for me...anyway, we'll see.

I have the app with the nutriniologist tomorrow. I do have more questions about how you guys in the US eat after an RNY, because I really want to do it properly this time, but I will ask that in the corresponding forum.

Thanks a lot once again, I really appreciate all your input!

Have a nice Thursday!

 

[southernlady]

The pouch is 40cc, not 4 cc; but the anastomosis is twice the original size, which means that I eat

That is known as the stoma and is notorious for enlarging and if corrected, has a major chance of failing again. Part of the problem lies in where it is...right at the bottom of the pouch. Which means that from day 1, your system acted like an open funnel.

While you consider all your options...also consider traveling to get the DS from a revision surgeon. http://bariatricfacts.org/threads/current-list-of-known-rny-or-lapband-to-ds-surgeons.1403/

 

[DSRIGGS]

I appreciate your desire to fix things non surgically, but we have seen too many examples to know that just really doesn't happen. Revising to a distal RnY would be a huge mistake. The real solution here is revising to a DS. Yes you will need to take vitamins but it is the only way you are going to lose weight if you have a broken metabolism.

Additionally I would never trust the surgeon who gave me a failed procedure to do what is right and give me the procedure I need.

My apologies if that seems blunt, but I think it is important to be honest. I know traveling to get a DS isn't what you want to do, but many of us it did when we realized we had to get to a surgeon and procedure that would fix us.

Best wishes

 

[Larra]

It's possible that the stoma wasn't too large at the start but stretched out over time. That's one of the most common reasons for RNY failure. Bottom line, while you acknowledge you could have done better with food choices, you probably would have struggled even with better choices because of the failure of your pouch to stay full for any length of time.
I agree with your surgeon about a lot of things -going to distal RNY would do nothing to solve the problem of a stretched out stoma, and the endoscopic (i.e. non-surgical) methods to fix an enlarged stoma have not been shown to be effective, so no point in wasting time and money on them - though sadly, there are still docs here in the USA offering this crap, and charging patients $10,000 for it, which is not paid for by insurance because it's experimental and doesn't work.
While I'm sorry the DS isn't available in Chile, I respect that the surgeon was honest and told you he'd never done it, and he is wise not to start on someone who already has RNY and would be higher risk for complications than someone who did not already have a prior surgery that would need to be dealt with along with doing the DS.
As to the new weight loss drugs, there are a few new ones in the USA these days, but none of them are miracle workers. The weight loss has not been dramatic. I doubt it will harm you to give whatever drug is being recommended a try for a few months, it just might not help a lot. Your best bet short of surgery is proper RNY diet, which generally means low calorie, low carb, and low fat, 3 meals/day and no snacks. At least, that's what the surgeons around here prescribe. I hope things work out for you, and if not, I hope you are open to the idea of travel, at least as far as Brazil, for a more effective surgery.

 

[KathrynK]

As for the drugs, he may be talking about the GLP-1 inhibitors which include medications that stimulate insulin and may decrease appetite and promote some weight loss. They can initially cause nausea. There are 5 or 6 of these drugs approved here, Victosa is name most recognized. Along the way, I met a woman who figured out the 'cost per pound of weight loss' of various pharmaceuticals and it usually exceeded $50 per pound per month (or even more). It isn't a dramatic weight loss for most people, maybe losing few pounds per month, or 15 pounds per year, at a high cost without insurance. Drugs are expensive in the US but if you have insurance or government cost controls, it may not matter. The weight loss is not going to be enormous for most people (but there are always exceptions) and none of the drugs are effective after you stop taking them. But in some situations every little bit helps. This is fairly complicated reading, but it might help understand his thoughts: http://www.ajhp.org/content/early/2016/08/10/ajhp150990.full.pdf

 

[galaxygrrl]

You know, I know nothing about this, but I thought there were good DS surgeons in Brazil. Not sure if you are up for medical tourism. Good Luck!