Roux-en-Y gastric bypass with lap band, enlarged stoma. Doctor wants to remove band. Will this resolve gas & stomach discomfort?

Question

I had Roux-en-Y in 2004 . My pouch enlarged and I had a lapband put in place in 2013 . I started having servere gas and stomach pain. Barium swallow showed an enlarged stoma and slipped lapband. The EGD showed no erosion and no slippage for the lapband. My doctor wants to pull the lapband, however i am afraid with an enlarged stoma my problem of gas and stomach discomfort will not end. What are my options?

Ali Solmaz, MD · Answer

Given your surgical history, it’s understandable that you're concerned about the best path forward. You've had a Roux-en-Y gastric bypass in 2004, followed by the placement of a lap band in 2013 to address weight regain or pouch/stoma issues. Now, you're dealing with severe gas and stomach pain, an enlarged stoma seen on a barium swallow, and conflicting results from your EGD. Your concern about simply removing the lap band without resolving the underlying issue&mdash;specifically the enlarged stoma&mdash;is absolutely valid.
The lap band might be contributing to your symptoms, especially if it's slipped or creating intermittent obstruction, but the gas, bloating, and stomach pain you're experiencing are also often linked to the enlarged stoma and reduced restriction from your original bypass. When the stoma becomes enlarged, food can pass too quickly into the intestines, leading to discomfort, increased gas, bloating, and reduced satiety&mdash;which can all interfere with weight maintenance and quality of life.
Removing the lap band is likely the right first step, especially if it’s suspected to be malfunctioning, even if the EGD didn't show definitive slippage or erosion. It’s also important to remember that EGD findings don't always align perfectly with what patients are experiencing symptomatically or what might be seen intraoperatively.
That said, removing the band alone may not resolve all of your issues. There are options to address the enlarged stoma directly. One possibility is a revision procedure, such as surgical pouch and stoma revision or conversion to a different bariatric procedure like a distal bypass or even sleeve-based revision, depending on your anatomy and overall health. Another less invasive option is an endoscopic procedure like Transoral Outlet Reduction (TORe), which can reduce the size of the stoma and restore restriction without additional surgery.
Your next step should include a thorough discussion with a bariatric surgeon who has experience in revision cases. These are complex and highly individualized, so a careful review of your imaging, endoscopy, weight history, and symptoms is essential in determining the best treatment plan. Be sure to ask about all available options, including both surgical and endoscopic interventions, and the expected outcomes in terms of symptom relief and weight control.

Felipe Garcia, MD - Account Suspended · Answer

I recomend to have a revisional bariatric surgery. This procedure allows the surgeon to review the surgery previously performed and determine if it is possible to modify. The revisional procedure consist of 1. Endoscopy before the procedure 2 . Remove the lap band 3. Adjust the bypass4. Endoscopy after the surgery It is necessary to have all the patient information like weight loss after the first surgery, weight regain, or any complication during the process.

Roux-en-Y gastric bypass with lap band, enlarged stoma. Doctor wants to remove band. Will this resolve gas & stomach discomfort?

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