Problems with solid food items after gastroplasty - Forum

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Arizona

Problems with solid food items after gastroplasty - Ärzteforum

Post#1 »

Encountered something I've never seen today - a gentleman 9 years out from a vertical banded gastroplasty - learned to eat even with it (no surprise there!) but now has problems occasionally with solid food items getting hung up in his stomach at the "ring." He wants to get it reversed because of this.

Any thoughts? Suggestions?


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A Doctor

Re: Problems with solid food items after gastroplasty - Ärzteforum

Post#2 »

I would avoid revision of obesity surgery unless there is an otherwise unremediable problem. This man should be told to chew his food throughly (20 times per mouthful is a good guide early post-op on the transition to solid food - "use your teeth like a vitamiser") and that this will most likely solve his problem.

If there is a need to do something more active, then (assuming you've assessed the stoma and proximal pouch with a limited dilute barium meal) endoscope him, and dilate with oesophageal bougies, gently. The previous surgery may have included a prolene suture to keep the stoma from dilating.

These patients are really manipulative, and a danger to themselves. I gave up doing bypass surgery three years ago, after 110 cases in 12 years, even though it was a great pleasure to find a slim attractive young woman in the waiting room that you didn't recognise six months down the line. While 3/4 patients did well, there was a handful who were a real pain and had hidden their peersonality or psychiatric problems very successfully.

This guy is likely to welcome the chance to overeat again after a reversal and then come back demanding another gastroplasty.

I expect with the new Angelchick-type inflatable-adjustable gastric bands that some patients will manipulate the device themselfes by deflating the reservoir. We had patients with jaw wiring who would vitamize a hamburger.

Montag surgeon

Re: Problems with solid food items after gastroplasty - Ärzteforum

Post#3 »

This is a common problem after this operation; the patient needs to chew his food better. It is unfortunate that he was not educated better before the operation. Has he lost weight? If so, he should be aware that he will gain it all back. If he is still morbidly obese, it would be reasonable to reverse the operation and convert him to a more effective weight loss procedure.

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