Expert: John Pilcher, MD - 9/25/2011

Question
CT scan with contrast, scope, all say all is well but since discharge from hospital and IV and IV med, am unable to eat, drink, slurp anything. Excrutiating nausea and vomiting. Tried zofran 30 mins before, tried clear, puree, cream, hot, cold, nothing works. surgery was 2weeks ago and surgeon says went well except part of stomach sleeve is very narrow, but enough for scope to pass thru. Surgeon has nothing to offer except for me to go to hospital ER every few days for IV to rehydrate. This is not life worth living at all. Can u advise anything concrete? Or more of wait, wait, will surely get better in 1 - 2 - 4 months. I need way to hydrate now - am so thirsty! But no sense to live this way - and I am a mental health professional so please do not advise counseling!

Answer
Lee,
I'm sorry to hear about your troubles after Sleeve surgery.  I do have one or two ideas, though I hasten to add that implementation will depend on local resources.  First, in my experience it is usually correct to give this some time - the gastric tube tissue tends to be rather stiff and inflamed at the outset, then gradually soften and become more flexible.  In order for you to be more comfortable and better hydrated while letting the healing continue, you and your surgeon might consider a PICC line or a central line that intended for home use, and arrange for you to receive IV fluids each day at home.  Typically, such fluids are infused over 8-12 hours each night, and the patient is then no longer "forced" to drink liquids for hydration.

If 1-3 weeks pass and there is no sign of improvement, then it can be appropriate to have a stent placed endoscopically (by scope).  This is a fairly specialized procedure, that is performed by only a few gastroenterology docs in a given area, so it may or may not be an option where you are.  Your surgeon will know.

If you have really prolonged symtoms without improvement, then re-operation might become necessary.  Depending on the exact site of the problem it may be possible to revise the Sleeve for better function, or it may be best to change to a gastric bypass operation.  Re-operation is definitely not an appealing option, but it can be necessary if things don't improve with "lesser" approaches.

Best of luck!
Dr JP