Expert: John Pilcher, MD - 11/16/2009

Question
I am 3 1/2 years out and I have gained 35 pounds. I am wondering if there is anything that my surgeon can do to see if my pouch is stretch or my stoma? Can they do a revision of my stoma if it is stretched?  

Answer
Amy,
It sounds like you had a gastric bypass procedure.  Later weight gain is unfortunately common, but not inevitable.  There are two main techniques for evaluating the gastric pouch, the outlet stoma, and the rest of the anatomy:  Upper GI X-ray, and Upper endoscopy (scope).  If you follow up with your bariatric surgeon, the odds are good that he/she will have a plan to assess your current anatomy.

Regarding the size of the stoma - there are several endoscopic procedures that aim to shrink the stoma when it enlarges.  Unfortunately, my reading of the literature indicates that all of these procedures have results that are only temporary, providing some small benefit for 3-4 months before sensation/restriction return to the same level as previously.

By the way, I recommend against the thought process which says "I'll lose back down to my baseline before I make an appointment, so my surgeon does not see me at this higher weight."  You need help, now.  So visiting back with your surgeon is your right next step.

Best of luck!
Dr JP