Long Termers

[CCPM]

Just seeing if any long term people are still out there. I pop in and read every day and see absolutely no-one who was here when I joined or had my op. Has everyone gone? Does no-one see this as useful for long termers? People seem to pop back if they have a problem or perhaps mark a surgiversary but no-one is there to chat too about long term things. I don't for one give a stuff if you didn't lose 150% of your weight or have regained, lets chat and see if we can help each other or celebrate those who have done well and share their secrets.

Believe me it is a whole different ball game when you get to 2 or 3 or 4 years and I do so wish others were here who were at that stage. if they remain successful they could share, if they have problems we could all pitch in to help. As it is I look elsewhere and feel sad to have to do so does anyone else feel that or am I talking to myself?????

I know that many feel its all about those who are pre-op or in the first year post op and yes thats when you are fearful need support, need to share your victories or bemoan your problems or stalls. However does it all suddenly go away at the 1 year mark which seems to be when most people have beggared off. Do newbies not need to know its not all new that some have walked the path before and felt the same and survived. Have all those that have gone left because they are all in full control, happy and getting on with life? Don't they need anything now from others in the same boat?

Its a mystery to me as I constantly need to know what others are doing, find things out to help me and assess how I'm coping. American sites have helped show me by reading others real long term experiences that the UK knows a fraction of what they do in terms of potential complications just by the fact it has been happening there for so much longer. I read time and time again how long and fairly short term post op people here (and in the US) have problems they present to their GP (mistake they know very little about bariatrics let alone complications) or local hospital with and get sent away. Nowadays with many new surgeons and hospitals undertaking bariatrics the surgeons don't have the length or depth of experience to have seen many of these problems and so don't identify them either. I sometimes worry when I read go back to your team, yes thats fine but our local hospital for example set up bariatrics a year ago and have done 33 ops. to date so yes start there but ask the relevant question i.e how much experience of this do you have as docs are beggars for believing they walk with god on a regular basis and are superior beings. I'm a partner to 9 of them. BUT where there are many long termers posting you can bet one of them will have either experienced it first hand or know something about it enough to say ask some more that's not right. For example how many know what a Petersens hernia is?? No well you should bypassers suffer these, they may be life threatening. How do you recognise magnesium or copper deficiency, its effects can be cruel?? Do you know why we need to take calcium as calcium citrate? More important does your GP and is s/he prescribing it in that form? I doubt it, its not the usual calcium on prescription. Do we don't we need B12 injections how is that monitored? The list is endless.

Is there any body there can we build a long term section for support???


Bariatric surgery can be fantastic I love my bypass it changed my life but it isn't all about the here and now its for life just like that pesky christmas puppy. Come on out and post if only to shut me up


M

 

[Miss Tickle]

Great post CCPM. I read every other day but would love to have somewhere to chat. I'm 14 months post op now and not at goal yet, and feel I need this support group as much as ever. I just don't seem to have much to say. Perhaps there could be a long termers section- not a maintainers as I'm sure lots of 12 month plus people are still trying to lose weight.
I do worry that people stop posting if they regain. I know regain is a real problem and it would be good to have support here for people in that position
xx

 

[fab40]

Great post I know what you been, I would like to know more bandits who have gone past the 1 to 2 year stage

 

[Mazza]

Hi

I had my band around the same time you had your bypass - April 09.

Not sure if you are looking for all long termers or just bypassers though

 

[Miss Tickle]

I'd like something for everyone long term post op Mazza.
xx

 

[emma-louise]

Just seeing if any long term people are still out there. I pop in and read every day and see absolutely no-one who was here when I joined or had my op. Has everyone gone? Does no-one see this as useful for long termers? People seem to pop back if they have a problem or perhaps mark a surgiversary but no-one is there to chat too about long term things. I don't for one give a stuff if you didn't lose 150% of your weight or have regained, lets chat and see if we can help each other or celebrate those who have done well and share their secrets.

Believe me it is a whole different ball game when you get to 2 or 3 or 4 years and I do so wish others were here who were at that stage. if they remain successful they could share, if they have problems we could all pitch in to help. As it is I look elsewhere and feel sad to have to do so does anyone else feel that or am I talking to myself?????

I know that many feel its all about those who are pre-op or in the first year post op and yes thats when you are fearful need support, need to share your victories or bemoan your problems or stalls. However does it all suddenly go away at the 1 year mark which seems to be when most people have beggared off. Do newbies not need to know its not all new that some have walked the path before and felt the same and survived. Have all those that have gone left because they are all in full control, happy and getting on with life? Don't they need anything now from others in the same boat?

Its a mystery to me as I constantly need to know what others are doing, find things out to help me and assess how I'm coping. American sites have helped show me by reading others real long term experiences that the UK knows a fraction of what they do in terms of potential complications just by the fact it has been happening there for so much longer. I read time and time again how long and fairly short term post op people here (and in the US) have problems they present to their GP (mistake they know very little about bariatrics let alone complications) or local hospital with and get sent away. Nowadays with many new surgeons and hospitals undertaking bariatrics the surgeons don't have the length or depth of experience to have seen many of these problems and so don't identify them either. I sometimes worry when I read go back to your team, yes thats fine but our local hospital for example set up bariatrics a year ago and have done 33 ops. to date so yes start there but ask the relevant question i.e how much experience of this do you have as docs are beggars for believing they walk with god on a regular basis and are superior beings. I'm a partner to 9 of them. BUT where there are many long termers posting you can bet one of them will have either experienced it first hand or know something about it enough to say ask some more that's not right. For example how many know what a Petersens hernia is?? No well you should bypassers suffer these, they may be life threatening. How do you recognise magnesium or copper deficiency, its effects can be cruel?? Do you know why we need to take calcium as calcium citrate? More important does your GP and is s/he prescribing it in that form? I doubt it, its not the usual calcium on prescription. Do we don't we need B12 injections how is that monitored? The list is endless.

Is there any body there can we build a long term section for support???

Bariatric surgery can be fantastic I love my bypass it changed my life but it isn't all about the here and now its for life just like that pesky christmas puppy. Come on out and post if only to shut me up

M

This is one of the best posts I've read in a while,I'm over 2 years bypass now.
And it's hard to find anyone on here with long term knowledge.
I do find now as I'm more long-term my outlook has changed from the start.
It was about looking good and the weight dropping off !
Now it's a worry about vitamin definencys,feeling tired,getting a lot of wind pains with bloating etc.
And you can't just pop into your local gps,as they have very little knowledge of baratric surgery.
So here is the only place for support and answers.
My bypass has given me my life back but the future can also be worrying as ive started to show signs of defiency and I've also get a lot of wind pains which is a side effect of this surgery according to the USA sites which are more advanced(as this surgery has been done more and longer)..
This site is great,but a section for long term people would be great.

 

[BlueDiamond]

I am over 2yrs banded.

 

[Cicca]

Anna; 5 years DS (sleeve and switch bypass) 2 year stable weight and tummy tuck.

No major problems, don't diet as such. Eat when I'm hungry, have a very active life working in the city. I do make better choices, mainly due to def knowing what I do and don't like eating. I naturally think protein 1st when I'm eating and if there's room carbs. Still love food, used to worry me that I'd lose this passion as I enjoy cooking - but it's better now as I can eat without feeling guilty.

I see hospital every 6 months still due to a few minor deficiencies. Low iron and vit A.

No regrets at all. Best up side for me is being able to look in the mirror and feeling happy with what I see. Walking in to a room and getting looks for the right reasons. Walking round London and being the last one wanting to go home!

Anna xx.

Sent from my iPhone using WLSurgery

 

[CCPM]

Its good to see replies and from all surgeries which is great. I've been asked for details of the Petersen' hernia so I'm pasting an article from a medical journal below, just hope that's OK. This is not I hope seen as scaremongering but I have seen 3 people in the past year suffer from this on another UK forum. Lets keep talking and find some more people to join in.

Petersen’s internal hernia occurs posterior to a gastroenteric anastomosis. Although rare, this hernia was well known during the 75 years in which chronic peptic ulcer disease was commonly treated by gastric resection and gastrojejunostomy. Since elective surgery for chronic peptic ulcer disease is now uncommon, a whole generation of surgeons may not be familiar with Petersen’s hernia at a time when this defect is making a resurgence because of the increasing popularity of Roux-en-Y gastric bypass to treat morbid obesity. Early recognition of this potentially serious condition is essential.

In the undisturbed abdominal cavity, the transverse colon acts as a partition between the stomach above and the small intestine below. Once a gastroenteric anastomosis is constructed, a potential space for internal herniation is created posterior to the limbs of the small intestine. The risk for herniation exists whether the anastomosis is ante- or retrocolic and whether the gastrojejunostomy is nonresectional or performed after a partial or subtotal gastrectomy.

In 1900, the European literature included a report by Petersen on the occurrence of an internal hernia after partial gastrectomy and gastrojejunostomy.1 Soon thereafter, similar reports appeared in the American literature. Throughout the greater part of the 20th century, there were frequent updates on Petersen’s hernia, and by 1974, 178 cases had been reported.2 This span of about 75 years was the era when peptic ulcer disease and its complications were common and every general surgeon was familiar with performing antrectomy, truncal vagotomy, gastrojejunostomy, or subtotal gastrectomy in conjunction with gastrojejunostomy, since these were the most popular and effective treatments for chronic peptic ulcer disease. Although Petersen’s hernia was rare despite the millions of gastric resections that had been performed, it was an appreciated entity, and several authors, including my former professor Dr. Alfred Markowitz, reported on its clinical presentations and the need to have a high index of suspicion because immediate surgery could be life-saving.3-5

Just as there was a rapid increase and sustained prevalence of peptic ulcer disease in the decades before and after WWII,6 there was also an unexplained and dramatic decrease in the prevalence of this disease preceding the development, acceptance, and use of histamine receptor antagonists that began in 1977.3 With the addition of other nonsurgical therapies, such as proton pump inhibitors and antibiotics against Helicobacter pylori, elective surgery for chronic peptic ulcer disease and its complications became uncommon. As a result, a whole generation of surgical residents has been trained with minimal exposure to resectional gastric surgery, methods of gastrointestinal reconstruction, and the resulting postoperative anatomy and complications.

Petersen’s hernia has recently made a resurgence due to the popularity of Roux-en-Y gastric bypass to treat morbid obesity. The single Roux limb forming the pouch gastrojejunostomy presents the same possibility for internal herniation as the loops of a standard gastrojejunostomy. The case that follows illustrates this problem in its most severe form.

Case report
A 51-year-old man came to the emergency department reporting abdominal pain, nausea, and vomiting 24 hours after arriving in New York City from California. He was hypotensive, tachycardic, dehydrated, and had a temperature of 96.2°F. His abdomen was not distended and no gross peritoneal signs were elicited, but there was diffuse tenderness upon palpation. The patient was hydrated and was able to produce urine after receiving 3 L of Ringer’s lactate solution. Laboratory examinations revealed a hematocrit of 51% (normal, 41%–50%), white blood cell count of 12,700/µL (normal, 4,500-10,000/µL), amylase of 83 U/L (normal 25-85 U/L), and pH of 7.26 (normal, 7.35-7.45). A plain abdominal radiograph revealed a diffusely gasless abdomen with one mildly distended air-filled small bowel loop in the left hypogastrium.

The patient’s surgical history included a successful laparoscopic Roux-en-Y gastric bypass 11/2 years earlier, which resulted in a 150-lb weight loss, as well as an abdominoplasty for excess skin laxity 6 months before his current presentation. Two weeks before his trip to New York City, the patient experienced mild intermittent abdominal cramping and occasional loss of appetite. A medical checkup found no abnormalities.



His initial evaluation at Roosevelt Hospital suggested the possibility of a compromised loop of small intestine incarcerated in a Petersen’s hernia. Within 1 hour of collecting the patient’s history and providing fluid resuscitation, he underwent emergency exploration. Because he was still mildly hypotensive, arterial and venous monitoring lines were placed. A generous midline incision was made, which revealed 1 L of nonodorous hemorrhagic ascites. The entire small intestine, from the jejunojejunostomy to the ileocecal valve, had herniated through a 4-cm Petersen’s hernia and was misplaced on the left side of the abdomen (Figure 1). All of the patient’s incarcerated small intestine was deep purple to black in color, and only the gastrojejunostomy limb and the proximal biliary pancreatic limb were pink (Figure 1). The compromised intestine could not be safely reduced because of the risks of creating an enterotomy and the possibility of spilling contents. The defect was instead enlarged by dividing part of the mesentery that formed the wall of the defect, and the severely compromised small intestine was then brought back to its normal anatomical position on the right side of the abdomen and pelvis, which resulted in a noticeable improvement in color (Figure 2).

After 7 minutes, the intestine was reexamined and was clearly less congested. Arterial pulsations were also observed in the distal mesenteric arcades. A 5-ft-long jejunostomy tube was fashioned and placed through the abdominal wall, and 2 L of hemorrhagic intestinal contents were removed. The hernia defect was closed with silk sutures. A large sheet of absorbable mesh was folded upon itself and quickly sewn to both sides of the divided linea alba, and the wide open subcutaneous and skin defects were filled with absorbent gauze and towels. Still intubated and hypotensive, the patient was brought to the intensive care unit for resuscitation and ventilator support until a second, planned laparotomy could be performed 24 hours later. Overnight, the patient underwent hemodynamic monitoring and continued fluid resuscitation and administration of broad-spectrum antibiotics. His acidosis, blood pressure, heart rate, and urine output normalized, and peritoneal fluid drainage remained clear and nonodorous. At reexploration, a long vertical slit was made in the mesh and the small intestine was observed to be grossly edematous and hemorrhagic but clearly viable. Cultures of peritoneal fluid were taken, the jejunostomy was checked for any sign of leakage, and copious peritoneal irrigation was performed. The mesh was then closed with a heavy running suture, and absorbent gauze and towels were applied as before.

After 3 days of intubation, sedation, and aggressive diuresis, the patient showed improvement in all areas. He returned to the operating room for further exploration, which revealed no sign of intestinal wall necrosis or leakage. Copious irrigation was performed, proper bowel position and closure of the Petersen’s defect were confirmed, the mesh was removed, and the linea alba, subcutaneous tissues, and skin were closed primarily. The patient had a slow but steady recovery and was discharged from the hospital 12 days later. For many months after the surgery, the patient had frequent loose bowel movements and excess flatus due to reduced small bowel absorption; however, this slowly improved, and when he recently returned to New York City, we shared a happy reunion and a hearty meal.

Discussion
Although Petersen’s hernia involves the potential space posterior to a gastrojejunostomy, its presentation and physical, laboratory, and radiography findings are similar to those for other internal hernias. Treatment requires reduction of the incarcerated bowel and closure of the defect. Any nonviable bowel must be resected.

In the early postoperative period following Roux-en-Y gastric bypass, mild intermittent symptoms probably represent partial small bowel obstruction with spontaneous reduction. The resulting nausea, vomiting, abdominal cramping, and pain may be attributed to a host of postsurgical problems including edema, angulation, small leaks at the anastomoses, hematoma, or adhesive obstruction. In the late postoperative period, symptoms may be ascribed to anastomotic stricture or adhesions, gallbladder colic, pancreatitis, or failure to follow dietary restrictions. Investigative computed tomography (CT) scans and upper gastrointestinal and small bowel contrast studies may fail to reveal an internal hernia in 20% of cases, especially if the radiologist is unfamiliar with the anatomical changes following Roux-en-Y gastric bypass or is not advised of the patient’s surgical history and the suspicion of an internal hernia.7

Without an awareness of Petersen’s defect and other spaces produced by the Roux-en-Y reconstruction that have the potential for internal herniation, a patient’s condition may go undiagnosed until an acute attack results in complete small bowel obstruction and vascular compromise. Such patients must be resuscitated quickly and undergo urgent exploration because small bowel infarction and sepsis may be only hours away. While some surgeons may wish to have the more detailed information that a CT scan can provide, the time needed to obtain imaging might result in an unfortunate delay of surgery.

Bariatric surgeons must pay special attention to closing all potential hernia sites when performing the Roux-en-Y gastric bypass; however, it is to be expected that occasionally sutures may be too widely spaced or may pull through or that significant weight loss with its accompanying loss of mesenteric fat volume may result in a defect. Therefore, every patient having Roux-en-Y gastric bypass should be considered vulnerable to an internal hernia, and any abdominal symptoms in these patients should raise suspicion of this serious entity.

Conclusion
Petersen’s hernia occurs posterior to the limbs of a gastrojejunostomy, and although rare, this defect was well known during the first three quarters of the 20th century when elective surgery for chronic peptic ulcer disease was common. Although this internal hernia has been rarely encountered over the past 25 years, it is now being seen with increasing frequency due to the large number of Roux-en-Y gastric bypasses performed to treat morbid obesity.

An internal hernia should be suspected in any patient having undergone Roux-en-Y gastric bypass who develops abdominal symptoms. Acute presentations that include significant abdominal pain and vomiting suggest severe bowel obstruction and vascular compromise and require emergency laparotomy.

 

[gonnabethinner]

i would love to see a section for long term postop too. afterall everyone who is getting their op will become long term postop, and i think we all will still need the odd bit of help even then, great idea!

 

[emma-louise]

Interesting reading about the peterson hernia.
It does seem to be the case bypass patients are not always told about the possible side effects of having this surgery in the long term.

 

[Yvessa]

I know I'm not long term but I hope you don't mind me mentioning that I was warned of this possibility. As well as the risks of malabsorption which is why they even refused to consider the DS for me even though it was the surgery I originally wanted.

 

[CCPM]

Not at all Yve it good to know some people are forewarned. My provider was great until post op then never heard another word. I pushed for a while but just gave up he kept apologising and blaming his staff, telling me what he had done to improve things but then nothing happened so I have had to be very self sufficient and it makes me wary, very wary so I continue to research and listen in many forums and what I read makes me more and more certain that long termers need to stick together whatever op and share information round.

 

[Yvessa]

I do agree that there is a gap between the reality and what our providers seem to expect though. I am grateful for every long termer who still posts here.

 

[happy days]

Iam 19 months post op bypass. I've got to be honest and say I stopped posting for a while or asking questions just because no one seemed to have a answer or opinion. Then there wa a stage when people were having petty battles.
But I've been back in a bit in the last few weeks, think long termers need a post. I was in so much pain at one point last week I nearly called ambulance. I knew deep down it was trapped wind but wud hav been great to have some reassurance from another long termer.

 

[CCPM]

Hi and good to see you posting if you ever need someone to speak to PM me I'm always about and always wanting to support/help

M

 

[emma-louise]

I know I'm not long term but I hope you don't mind me mentioning that I was warned of this possibility. As well as the risks of malabsorption which is why they even refused to consider the DS for me even though it was the surgery I originally wanted.

I was warned too about the general risks of gastric bypass..vitamin defiency,malabsorption,but was not mentioned was the wind pains/bloating... in America they call this a Charlie horse!
But at times I'm unable to move with the pain until it passes.
And the vitamin definency was mentioned but i was under the impression it could happen in years to come.
I was 15 months out and started to show signs in several levels.
But I still would have had this op done x

 

[pandora]

Good thread
I'm not long term ( 6 1/2 months ) but think its valuable for long termers
I was warned about hernias & malapsorption .
I don't post a lot ar the mo as I seem to be doing ok , but read daily & find it a comfort to know the site is here if I need support

Sent from my HTC Wildfire using WLSurgery

 

[lamornamiss]

I am nearly 2 1/2 years post op.
I pop in to read new threads every day and give advise when needed but tend not to post too much any more.
I was discharged from my bariatric team at around 12 months after my op as I was under the care of my weight management team, I have been seen by them every 3 months since my op (they do all my bloods etc.) I have now been dropped to every 6 months and will soon only be seen once a year.
Great idea M

 

[Hanako]

I am wondering about the long term implications of weight loss surgery (especially the gastric band which I am planning to have). Ok, I will loose the weight, but how safe it is going to be to have the band for perhaps the next 40 years? Will it last, or will it corrode into my stomach? Will it damage the stomach so badly that I may not be able to eat at all? Could it cause cancer? I think maybe the procedure hasn't been around long enough to give us all the answers. Maybe the consultants don't know the answers themselves.