Question:
Staple Line Eruption?? Why & How to Correct
2 yr po open RNY needs info on causes of Staple Line Eruption and how it's repaired. I started out having continued esophageal spasms, dry heaves, nausea, right sided upper abdominal pain, with 20 lb weight gain all within the last 3 months or so. I have no idea how this may have happened to me, what my opions would be for repair if any at all, and if BC/BS PPO would cover this kind of repair. I'm so devastated and confused, any help/comments would be greatly appreciated. Thank You — Barbara M. (posted on November 10, 2003)
November 10, 2003
Barbara,
I have seen this discussed at http://groups.yahoo.com/group/DS_Revision/ -
I haven't experienced it myself, though. Maybe someone at this Yahoo group
will be able to offer you some knowledgeable advice!
Blessings,
dina
— Dina McBride
November 10, 2003
You need to immediately see your surgeon (or your local emergency
department) to determine the exact cause of your problem (an ultrasound or
MRI would probably show if the staple line is broken). Then, assuming that
you were not transected, your staple line eruption could have been caused
by just a mechanical glitch in a few of the staples (it happens sometimes)
or by pushing the limits of your pouch a little too often (the risk of a
staple line break is greater if you are merely divided and not transected).
Secondly, insurance should cover the repair as it is critical to your
health (particularly given the extent of your side effects). Lastly, but
also very importantly, is to try to understand why you think you've been
gaining weight when you've been suffering from nausea for a few months--
the answer to that question might help you in trying to understand your
staple line broke down (if it did). Don't hesitate to get this checked--
you've put in two long years in getting healthy and deserve the second
chance that having the staple line fixed will give you.
— SteveColarossi
November 10, 2003
Hi, I am 2 yrs post op from my revision to transection after disrupting at
about 9 mos post op. It was devastating and I know just how you feel BUT
you must realize this is not your fault! I am assuming you were not
transected and this is a mechanical failure of that. The staple line does
not form a good tight seal with scar tissue when you are just stapled no
matter how many rows you have. I had 8 rows. The staples just come loose
and then the food flows over the pouch into the old still attached stomach.
I did have BC/BS Fed program and they denied my revision at first because
they said it wasn't medically necessary to fix it! Bah Humbug~ They are
crazy. I had a secondary insurance of AETNA and so rather than waiting to
fight BC/BS I just went to the secondary. It paid everything. I think if
I had shown medical necessity to BC/BS they would have covered it. I was
lucky in that I was able to get mine repaired quickly and didn't gain any
weight. But I would have gained it all back if I hadn't had the pouch
transected. Transected means physically separated by cutting and then
stapling and then oversewing the line. The little pouch is apart from the
old stomach. It is no longer connected. This assures you that you won't
have staple line disruption. Staple lines can disrupt (if not transected)
at any time....6, 7 years down the road even. Please don't feel despair
because you can have this fixed and the second surgery (although it will
have to be open too) is a lot easier because if you are like me, your
bypass is still intact. I understand exactly how you must feel. I was
almost suicidal when this happened to me but luckily, Michelle Curran and
Shelley helped me to understand that it was not my fault. You cannot
OUTEAT your pouch. I hate it when people (who do not know what they are
talking about) state that "so and so just ate so much her pouch
disrupted". NO WAY ! If a person would do this it would take many
months of constant overeating and stuffing and pain!!! I advise you to
have an upper GI done immediately in order to determine what needs to be
done. I hope your surgeon will transect this time. Find one who will.
Oh, and one more thing: This is considered corrective surgery and most
insurances should cover it. If BC/BS gives you trouble, just don't give up
and bug them to death. I had a hospital administrator advise me just last
week to keep bugging them and bugging them and bugging them. I am trying
to get approval for a TT and hernia repair. Never give up your dreams! I
lost 68 lbs before my SLD and now I have lost a total of 120 lbs. And
there is one more thing to look forward to: Another honeymoon period when
you lose quickly. God bless you. If I can be of further help, just ask.
My profiles tell my story in detail.
— Mylou52
November 10, 2003
Yeah, what Marilyn said. My SLD at 5 yrs. I see LOTS of us kind so knew
immediately when I had a pouch full of acid that it was not My Turn. But
since I kinda expected it, no time wasted on guilt or anything. JUST FIX
IT. My ins company said, "Oh? A repair? I dont' see why not." and
presto, it was done. While I was waiting for the letter to be written at
the doc's (don't ask--lol), I had plenty of time to pre-load protein, beef
up for surgery. Except for hurting a lil there and needing naps, my
revision was absolutely a "non-event". I lost the coupla lbs I'd
gained and was the same as before revision. Except now I can often chicken
& rice and couldn't before. Go figure. There IS no fault or blame with
mechanical failure. May as well beat yourself up for a flat tire or a snow
storm.
— vitalady
November 11, 2003
Not to sidetrack Barbara's concerns, but not all staple line disruptions
are purely mechanical glitches. It is possible (and I have seen at least
two occurences)where patients (particularly those who are not transected)
can eat through their surgery, given that the staple line is not absolutely
impervious. The fact that the poster chronicled a 20 pound weight gain
(while experiencing intense nausea) and a staple line disruption does give
rise to the possiblity that consumption may have been a factor. We all
make mistakes in dealing with food after surgery, and unfortunately, for
some of us, the cost of those mistakes is more than just getting sick for a
few hours or gaining a couple of pounds. However, nothing should detract
from the pain and the uncertainty that Barbara is enduring and the need to
seek immediate medical treatment and to then move forward.
— SteveColarossi
November 12, 2003
Hi Steve, please advise where you received your information that one can
have SLD by overeating? I don't see how it is possible because the pain
would be horrible! When one is not transected, the chance of disruption is
alwsys there because the body rejects foreign objects in some patients.
With SLD a patient feels bad enough without having the blame put on
him/her. We failed all our lives and now to fail at our last chance? No,
this is not the reason people disrupt. I am sorry but I just don't see how
it is possible to bust out of your pouch by overeating. Any surgeon who
does not transect these days is putting his patients at a risk of
disruption and the assurance that transection can prevent this is something
all surgeons should consider. I don't see why respectable surgeon would
not transect. Aside from this controversy, I would never place the blame
on the patient. Would one blame a person who has diabetes when they lose
their sight? I don't think
so. Good luck Barbara. I see where your SLD has been confirmed. Don't
waste your time or energy on blame. Just get it fixed as soon as possible
and all will be ok. This time make sure you are transected. Been
there/done that and I understand.
— Mylou52
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