Can a bad incisional hernia keep RNY from working effectively?

I have a pretty bad surgical hernia on the left side of my midline. I was done open. I did lose, initially, 179 pounds from 390 to 211. I have for the most part, stayed between 240 - 255. I just heard from a coworker that my hernia can effect how well the tool works for me.

Problem #1 My bariatric surgeon in HOU retired.

Problem #2 I am in Lake Charles, La and my PCP isn't versed in RNY at all. There are two local guys but I will not consider them. I will go back to HOU if needed for any revisions or hernia repairs.


Bottom line: Has anyone else ever heard that comment or anything close it what my coworker said? I have no clue as to where she got the info from.

I know there are many variables. My level of activity, what I eat, etc. Honestly, I am sure I could improve there.





Thanks in advance,


Jeff W Waldrop

Technically, if your hernia is interrupting your pouch in any way, most likely would interfere with your ability to eat, and most likely you would be in immense pain, with a lot of nausea as well.  I can't imagine how any type of hernia in itself would cause you to gain weight.  Any good general surgeon or even a PCP should be able to get you evaluated, and referred to the appropriate doctor if you need help faster than you'd have to travel for.

I had hernia and the pain after eating made me eat less. Hernia and pain made me lose weight.

I also had an open rny.  I was actually at a plastics consult to revise the ugly scar.  Once the ps looked at it, he indicated that I had a large hernia.  I really had no symptoms - no pain.  Although I did have this one area of my abdomen right below my bra line that seemed to stick out some once I ate something.  He called in a general surgeon and the two of them repaired the hernia with mesh and closed me back up - greatly improving the ugly bariatric scar that was there.  Perhaps you want to go that route for a surgeon.  After surgery, no protruding below the bra line anymore.  For the repair, I had to go back to nothing to eat or drink for the first day, liquids for the next two days, and then on to solid foods after that.  So, it was like doing the 5 day pouch test - I believe that I was back to eating less immediately after surgery and did wind up losing a few pounds.  However, I don't believe this was due to any interference of the hernia with my digestion.

I, too, had a large incisional hernia after my open RNY (the hernia was large enough that my surgeon installed a 6x6 inch piece of mesh to ensure proper repair and that it would not recur (which apparently can happen with large ones like that)), but I cannot imagine how the hernia could POSSIBLY effect how your RNY "works".

Your RNY works in two "mechanical" ways (plus one "behavioral" way), neither of which would be altered by a hernia.

The first mechanical way is by having the small pouch that helps limit food volume (and therefore HELPS control caloric intake). Your pouch is located just high enough up to be underneath your ribcage and therefore quite protected. Anatomically, the pouch couldn't possibly get pulled up into the muscle tear, and even if it COULD, that wouldn't enable you to eat more, it would enable you to eat less if the pouch was somehow constricted by the hernia.

The second mechanical way is temporary malabsorption of calories and fats. There is no way that a hernia could alter the intestinal bypass and cause you to absorb more calories or un-do the bypass causing you to return to normal intestinal functioning.

So, I believe your coworker is very misinformed. (Did you ask her where she heard such a thing?)

Then there is the behavioral component (and you have already indicated that you could improve in that area). RNYers gradually lose most of the caloric malabsorption component of the surgery. After about 18 months, you return to absorbing most (but not all) of the calories you eat, so as time passes during those first two years, you are gradually getting more calories even if your eating remains 100% unchanged. Just that process can cause weight loss to slow or cause SMALL amounts of regain. Most regain, however, is because we begin allowing our portion sizes to creep up too high or allow too many "bad" carbs or other unhealthy foods back into our daily diet. As anyone who is more than 3 years out can tell you, it is VERY easy to have that happen. We have to always remain vigilant about what we eat.

You don't need a bariatric surgeon to fix your incisional hernia, BTW. (Although I definitely DO understand wanting to use a surgeon that you already have confidence in.) Since your pouch and intestines are not involved, it doesn't really matter that your digestive system has been altered. It is not a complicated surgery and any competent general surgeon (or plastic surgeon who does tummy tucks, for that matter) can do it.

Lora

Thanks to all the responses! I go see my PCP first and go from there....


Jeff W Waldrop