The Surgery - Gastric Bypass

I arrived at the Hospital at 7 AM the day before the scheduled operation. At the time of admissions it was revealed that I weighed in at 362 pounds. There are a lot of things done to you when you check in at the hospital before admission for surgery. Of course they draw a lot of blood, chest x-ray, and now they insist on an HIV test- no problem. Then I was taken to a room that had a big plastic bubble with all kinds of tube and wires coming out and connected to several computers. I climbed in and they sealed the door shut. Here they put me through several breathing tests while injecting different types of gases into the bubble with me. ? A GAS CHAMBER ? It was okay.

Now off to the Hospital Diet Counselor, who clearly didn't know what she was talking about. After about 20 minutes of her babbling, I ask her how much experience she had in this area. She said I was only her 5th patient. Then I ask her how many Weight Loss Surgery patients had she worked with, she said I was her first... My wife and I got up and walked out.

Now a fast trip across town for the doctors office. At this time all the results of the mornings test were checked by Dr. Cowan and I was given the go ahead. Now Rush Back to the Hospital and get a room assignment so the fun can begin.

This day started at 7:00 AM and by the time I got my room assigned it was around 8:00 PM, I have been NPO (no food or drink) since bedtime yesterday! I was starving, after all I am a fat man - I need food! I told the nurses I needed something to eat and drink. That is when I was told they were bringing me something special...

Special all right ... a one gallon jug of Laxative! I was told to drink this down completely by 10:00 PM, then they handed me an enema to go with it. Of course the laxative tasted terrible but I drank it down. I didn't think the enema was necessary but I used it as instructed also. My goodness, this turned out to be a long night. I stayed in the bathroom till the wee hours of the morning. I was afraid to get in the bed for fear of an accident. But eventually it was clear I was cleaned out and very tired, so to bed I went.

Notice in the picture below, I am in bed drinking down the laxative a glass at a time with a smile on my face. This was before the enema and before the laxative all started working on me at the same time!

Morning came quickly.

During the morning there was not very much talking. My Mom was gathering her things and getting ready for all of us to depart from this room soon. Diane, my wife, stood by me holding my hand. Then the Knock at the door...

The attendants were there to take me to the operating room. Mom squeezed one of my hands -- Diane squeezed the other. All I could do is look at them, tears welled up in my eyes, my voice got stuck in the back of my throat. I nodded my head and I was off ...

Then just a few feet down the hall I felt this terrible cold chill pass over me and I sat straight up on the stretcher. I told the attendants to “Stop!” ....”I’ve changed my mind, I do not want to go to surgery!”

My family all rushed out into the hall and stood by my side. Everyone expressed that it was my decision. They were all on my side and if I wanted to cancel we could get up and get out of there right now. Or if I want to have the surgery they still supported me 100%. I was confused and wished someone else could make this decision for me. I just lay back on the stretcher and thought:

My life now is miserable, many times I have just wanted to die. The emotional pain has been terrible and the physical pain has begun to make me a recluse and not want to go anywhere. I really do not have a life. If I die in this surgery at least there will be no pain, it will all be over. But if I do survive then I actually do have the second chance on a quality life and it can be a longer, healthier and happier life. I looked at everyone with teary eyes and said I wanted the surgery. With that I was off....

I was surprised to see how busy the Operating Room area was. There were so many patients lined up in the hall with me, waiting, waiting, waiting… I was lucky I was parked next to the wall just below a large dome shaped mirror, and without raising up I could watch the people coming and going from all directions. Then they came for me. I was taken to a very brightly lit room which was so cool, it was almost cold. The people in the room with me were all busy doing their own specific jobs almost unaware of all the other happenings around them. Several people were suddenly around me, off with the gown, arms strapped to armboards, pieces of equipment moved over next to me, and then trays of covered surgical instruments were brought to my side. I knew it was time for me to go to sleep, or at least I wished it was.

I felt a warm hand on my shoulder and looked up to see a familiar face, Dr. Hiller. He is Dr. Cowan’s assistant, and in that comforting voice I have come to know he introduced me to the doctor who was going to put me to sleep and told me to just relax everything was going to be just fine. The anesthesiologist started an IV and that was the end of it. Maybe I should say that was the start of my journey to an new life!

Postoperative Diagnosis:
(same as above), plus gallbladder disease with pericholecystic adhesions.

Procedure:
Exploratory laparotomy, extended bypass Roux-en-y, retrocolic antegastric with divided stomach, gastric banding with steel wire; wedge liver biopsy, enterolysis, cholecystectomy, selective Vagotomy, modified Hill hiatus hernia repair, Stamm ante-Gastrostomy. Proximal gastric pouch formation, Gastro-enteric anastomosis.

Operative Findings:
The Liver was enlarged compatible with clinical examination; the kidneys were grossly normal by palpation, allowing for the perinephric fat precluding a more detailed exam. The small bowel from the ligament of Treitz to the cecum was 23 feet long. Large amounts of fat in the small bowel mesentery extending over the wall of the bowel towards the antimesenteric border, particularly the ileum.

Cholecystectomy:
The gallbladder was removed.
Pathologist's report: This is an 8.0 cm in length, 3.5 cm in diameter, partially opened, green-tan gallbladder with no serosal adhesions or exudate. On opening, the specimen contans a moderate amount of thick dark green bile and several small gallstones with the consistency of sand. The gallbladder wall is 0.3 cm in thickness. The mucosa is dark green and velvety with foacl areas of cholesterolosis. Chronic cholecystitis and Cholelithiasis.

Enteroenterostomony:
A measure of the length of the small intestine was marked at 7 feet from the cecum. The jejunum was transected two feet from the ligament of Treitz. And again transected the jejunum and its mesentery three feet more distally, performed a functional end-to-end anastomosis between the pox proximal and most distal stapled ends. Also performed a functional end-to-side anastomosis between the proximal end of the more distal transection and the previously placed marker at the seven foot distance from the cecum.

Proximal gastric pouch formation:
A linear cutter stapler line placed along the lesser curvature. It left excellent staple lines with a good cut. Through this access we then were able to directly dissect up in the posterior cardia to the angle of His. Blaa, Blaa, Blaa ... they made a small one ounce pouch!

Selective Vagotomy:
The anterior leaf of the gastrohepatic ligament was divided as the first part of the elective vagotomy. After completing formation of the proximal gastric pouch, an isloated portion of the posterior vagus nerve was resected. This completed the selective vagotomy, it being their terminology for the combination of the posterior truncal vagotomy with the anterior super-selective vagotomy.

Gastro-enteric anastomosis:
An opening was made in the mesocolon and advanced the Roux-en-Y stapled end through this opening. Then an equivalent opening in the small bowel and anastomosed the two openings together.

Gastric Banding with Steel Wire:
A stainless steel wire suture marked with ##-0 silk ties for a 6 cm circumference was placed about the middle poprtion of the proximal gastric pouch. It was placed with the rubber bougie in place and serves as a wire band to prevent distal dilatation of the gastroenterostomy with excess food thorought.

Modified Hill hiatus hernia repair:
Repair of a sliding hiatus hernia by a modified Hill hiatal hernia herniorrhaphy, approximating the cura of the diaphragm to one another.

Stamm ante-Gastrostomy:
The surgeon tacked approximately the midpoint of the greater curvature of the stomach to the left infracostal parietal peritoneum and fascia in a straight line parallel with the midline incision. Then made a small opening in the center of the peritoneal area and there placed three large hemoclips as radiologic markers. Then tacked the stomach to the peritoneum at the mid-points and corners of the vertical sides of the rectangle. Note that a large hemoclip radiolocic marker was also placed across the suture at each of the corners of the rectangle. The gastrostomy will be radiologically placed as required.

Liver Biopsy:
Obtained a wedge liver biopsy of the leading edge of the left lobe of the liver.
Pathologist's report:
This is a wedge of soft brown tissue with the cut surface a pale tan.
Fatty metamorphosis, predominantly paracentral.