Expert: John Pilcher, MD - 9/8/2010

Question
I had a vbg done in late 80's then a yr later had staple disruption and had it repaired, then approx 2 yr later had to have open gall bladder surgery and then in 2000 had to have open stomach surgery to repair 5 hernias where they put in mesh to repair them, but was cut down stomach along the line of my previous vbg's. I lost nearly 120 pounds in the first year and half but never reached my goal, since then I have gained nearly all of it back, I have dieted and lost then gained back numerous times, right now I am 100 pounds over the weight that I think I need to be at which is 170-180 pounds, I'm 5'9" and big framed,and 57 yr old. I have fibromyalgia, acid reflux,I take prilosec daily for it, I have to sleep in a recliner, on my left side with my head down because I vomit in my sleep on a pretty regular basis and have woke up not able to get my breath with vomit coming out my mouth and nose and unable to even cough it up out of my lungs for 15-30 minutes I'm gasping for breath and trying to cough up what has went down into my lungs,can't get air down or out.  I really fear for my life, I can't explain the fear and pain I have when that happens.  I honestly think that if I don't get this vbg revised that I will actually die from drowning in my own vomit, and it seems to be happening more frequent. Also the opening to the vbg is only the size of a pencil eraser, so I get things hung up in it all the time, a day rarely goes by that I don't vomit several times or more. I can't swallow pills, and I've had to go in for emergency treatment several years ago to have a tiny piece of pineapple removed that was blocking the opening for about 5 days.
I don't have my medical records from my vbg's, several yrs ago I contacted the clinic and hospital to get them but they told me they had destroyed all the records.
I have got to do something before I die in my sleep, but I don't know if the surgery would be so complicated and dangerous because of all my previous surgeries that it would be too much a risk. Please give me some advice as to what I need to do and some names of some qualified doctors in Arkansas or surrounding area that could help me.
Sincerely,
Cayla  

Answer
Cayla,
I believe you are correct in your sense that you are facing a challenging and urgent situation.  Unfortunately, the scenario you describe with progressive worsening of reflux/regurgitation into your throat and lungs is commonly seen after the VBG.

Although revision surgery will be challenging, it must be done in order to prevent recurrent lung infection and possibly permanent damage to your lungs.  Most likely, the right procedure for you will be to revise from the current VBG anatomy to a gastric bypass, though a surgeon will only know for sure once he/she has seen your X-rays and maybe an upper scope.

I recommend you begin your search for a qualified surgeon by looking for a Center of Excellence in bariatric surgery.  You can find a listing of surgeons on the web here:
http://www.surgicalreview.org/locate.aspx

I recommend for you to be "up front" with your surgical history when you call the surgeon's office.  I say this because even at a Center of Excellence, not every surgeon will have the experience and confidence to handle your case.

Best of luck!
Dr JP