AboutJohn Pilcher, MD Expertise I can answer medically oriented questions about bariatric surgery including: patient
selection, preparation for surgery, differences between types of bariatric surgery, aftercare
following bariatric surgery. I can answer detailed questions about gastric bypass, Lap-Band, gastric sleeve, and revision bariatric surgery. I am only somewhat familiar with
Biliopancreatic diversion. I am not prepared to answer insurance or other financial
questions related to bariatric surgery.
Experience I have been a practicing bariatric surgeon since 1995. About 85% of my current practice consists of bariatric surgery, including all of the above procedures except biliopancreatic diversion. I am the senior surgeon of a 5-surgeon group. I am recognized among surgeons and other medical professionals as the most experienced bariatric surgeon in my region.
Organizations Fellow of American College of Surgeons
Member, American Society for Bariatric Surgery
Education/Credentials BA in Biochemistry - University of Virginia
Medical Degree - University of Virginia
Surgical Residency - University of Virginia
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.
