When Your Stoma Fix Breaks Down

Bariatric surgery passed its Golden Anniversary in 2004. During the past five decades, numerous procedures, beginning with jejunoileal bypass, have come and gone. The concept of "stomach stapling" which produces substantial restriction of food intake evolved in the 1970's. During that era, measurements of the pouch volume capacity and stoma size were reduced to dimensions that supposedly allowed patients to eat with an acceptable degree of discomfort and still lose weight. However, keeping the weight off was a problem. Stretching of both the pouch and stoma were cited as the main culprits of weight regain after the early stomach stapling procedures. During that early era, two surgical techniques were introduced to reduce the size of a stretched stoma:

1. banding the stoma with prosthetic material which eventually evolved into the current adjustable gastric band.
   
   
2. Suturing the stoma circumferentially to make it tighter which evolved into the current StomaphyX.
   
   

In the 1980's and 90's, the procedures used for stoma size reduction, gastric banding and stomal suturing were performed through large abdominal incisions. Nowadays both adjustable gastric banding and StomaphyX are performed using minimally invasive techniques. In fact, no incision is required for StomaphyX procedures.

During the past three decades, it was also learned that weight loss failure after a bariatric operation involving the stomach was almost never remedied by merely adding more "restriction" in the form of either banding or suturing the stoma. To date, there have been only isolated success stories of banding a failed gastric bypass and essentially no long term success associated with either suturing or gluing (another reported approach) a stretched stoma.¹ Conversely, experts have found that surgical approaches adding malabsorption to either a failed banding or gastric bypass offer reasonable hope for satisfactory long term weight loss.^{2, 3}

Dr. Brolin and Dr. Chau of NJ Bariatrics have the widest experience with revisional bariatric surgery in the New Jersey, New York and Pennsylvania area. So when your stoma fix breaks down, be sure to contact us. Take comfort in the fact that we have an unparalleled success rate in repairing these breakdowns. 

1. Spaulding L, Oster, T, Patlak J. Long term results of sclerotherapy for dilated gastrojejunostomy after gastric bypass. Surg Obes Rel Dis 2007; 3:623-626.
2. Parikj M, Pomp A, Gagner M. Laparoscopic conversion of failed gastric bypass to duodental switch: technical considerations and preliminary outcomes. Surg Obes Rel Dis 2007; 3:611-618.
3. Brolin, RE, Cody RP. Weight Loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg 2008; 248:227-232