Diagnosed with hiatal hernia of pouch. Had gastric bypass in 2011. My pouch and stoma has dilated. Can this be due to hernia?

Question

oct 2010 I went back to surgeon to work on weight regain of 40 lbs of the 140 I lost. he did xray of me swallowing this stuff and my pouch and stoma were in place and fine. now a year later I am told my pouch as herniated and my pouch and stoma have dilated. how could this happen in a year and could the herniated pouch had cause the dilation?

Wiljon W. Beltre, MD · Answer

Dilation of the stoma happens to almost every one that has a gastric bypass.  The hiatal hernia did not cause the dilation of the stoma.  Stoma dilation happens almost always.  The hiatal hernia however caused the pouch to herniate.  The notion that dilation of the stoma causes weight regain is wrong.  Some gastric bypass patients regain weight because their hunger returns and they find them selves multiple times through out the day (grazing).  They eat small meals and do get full, however because of hunger they end up eating many times through out the day.  If the dilated stoma was the problem, tighten up the stoma would stop weight regain,  yet it does not, the stoma re-dilates.  There are only two viable options for gastric bypass patients that have regained most of the weight back, revise it to a distal bypass or take down the bypass completely and revise it to the BPD-DS.

Shawn Garber, MD, FACS, FASMBS · Answer

Dilation of the gastric pouch and stoma which is the connection between the gastric pouch and small intestines is not an uncommon problem after gastric bypass surgery and can lead to weight gain.   There are a few options for you to consider if this weight gain continues.  There are Endoscopic procedures using an Apollo Overstitch Device to tighten the stoma and in our practice we commonly perform band over bypass where we place a Lap-band on the upper portion of the stomach that is adjustable and can control the flow of food through your stomach pouch.  Your hiatal hernia could be fixed at the sometime as this surgery. It is important to seek out a surgeon with a lot of experience with revision surgery and specifically these procedures.

Elias Darido, MD, FACS · Answer

Pouch and stoma dilation are common findings after gastric bypass surgery. A small hiatal hernia may also be present. It takes several years after surgery for pouch and stoma dilation to occur. Most importantly pouch and stoma dilation are not a cause of weight regain in most patients. A hiatal hernia does not cause pouch and stoma dilation unless the pouch has herniated into the chest and created pouch outlet obstruction in which case you would be vomiting and unable to swallow food. I hope this helps.

Diagnosed with hiatal hernia of pouch. Had gastric bypass in 2011. My pouch and stoma has dilated. Can this be due to hernia?

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