WLS "Champion" dies 8 years post-op after his entire bowel dies

[HereticFA]

Public media outlet:
http://www.kristv.com/global/story.asp?s=4162121

More details:
http://www.bariatricsupportcenter.com/index.php?module=pnForum&func=viewtopic&topic=2490&start=0

(Sorry for the line break in the second url.)

[fatlane]

Man, if you get the surgery, be sure to do the maintenance on it... Just having the procedure doesn't mean it's all over and done.

[MissToodles]

I know surgery has its down side and certainly not a pancea for obesity. But there is this vein of hatred that runs through size acceptance, that people who get it almost deserve the ill health and death that sometimes can accompany it.

[Sasquatch!]

I know surgery has its down side and certainly not a pancea for obesity. But there is this vein of hatred that runs through size acceptance. People who get it, almost deserve to die. I wish his family well.


Are you saying ppl who have wls deserve to die? :confused:

[LillyBBBW]

It's a strange sensation feeling that people are poised around you waiting for something bad to happen so they can exclaim, "AHA! I told you so." Both sides are guilty of that though.

[LillyBBBW]

Are you saying ppl who have wls deserve to die? :confused:

I think she was saying that there's a vibe that comes from the size acceptance community that appears to gloat over the death of someone who has had wls.

[MissToodles]

I would never wish death upon anyone who got the surgery. I have very mixed emotions over it. I know my mom would still be large but in better health without it. I also know some people do very well post-op. This board is entitled "wls controversy", so all sides should be heard.

[HereticFA]

I posted the links since so many interesting facets are being presented.

I learned from another article that Mr. Collins was involved with a bariatric surgeon, acting as a paid employee. With that level of access to a pool of knowledge, how could his condition degrade so far? Was it complacency or neglect on his part or someone else's?

Even though his death is due to a health problem associated with gastric bypass, his family is quoted as not believing his death is related to his WLS. That shows a phenomenal level of denial. Obviously the same level of denial that caused him to ignore the severe abdominal pains he must have experienced as his colon was dying. (What a horrible way to die.)

Most especially, since everyone seems to focus on making it thru the first two years post-op, his death at seven years post-op should be a wake-up call to supporters of WLS. If Mr. Collins hadn't been cited as a spokesperson for WLS, would his death have made the news? I suspect it wouldn't. It takes a high profile person in a discipline or community to make it newsworthy.

I wonder how many people he supported and guided on their WLS journey are now second guessing their decision after the death of their mentor? I suspect most deny it is related to his surgery.

[Sandie_Zitkus]

I just wanna say thanks Ray for the link to that story. It sort of reinforces a question I have had for years and years about WLS. That question being:

"What happens to the intestines that are bypassed and left in the abdominal cavity?"

I guess the answer is - it dies - slowly.

This whole thing makes me want to hit somebody HARD! :mad:

[Webmaster]

I know surgery has its down side and certainly not a pancea for obesity. But there is this vein of hatred that runs through size acceptance, that people who get it almost deserve the ill health and death that sometimes can accompany it.

I have seen that and it's not right. Absolutely not. One may regret that someone made such a decision, but bad treatment of people who chose to undergo WLS? No way. I do, though, have a vein of hatred only for those who practice and promote this dangerous, experimental surgery for their own financial gain.

There will be those who feel the trade-off of a few years of life at a much lower weight is worth the possibility of an early death, especially since no one has an alternate answer for those who are desperate and have a reason to be. After all, there are other life-prolonging drugs and operations, but that analogy only works if one indeed views obesity as a disease.

Overall, it baffles me how a procedure is legal that can leave a very well informed WLS posterchild with a completely dead bowel after just a few years. That was certainly a chilling report from the victim's own daughter.

[Miss Vickie]

I just wanna say thanks Ray for the link to that story. It sort of reinforces a question I have had for years and years about WLS. That question being:

"What happens to the intestines that are bypassed and left in the abdominal cavity?"

I guess the answer is - it dies - slowly.

This whole thing makes me want to hit somebody HARD! :mad:

In a healthy individual, the intestines shouldn't die from being bypassed, because they're still getting a blood supply. That's like saying that a man's scrotum would die from a vasectomy. Yikes! Or that once a woman has a tubal ligation, her fallopian tubes will die. They don't, although they have noticed unexpected changes in women's cycles after tubal ligation, which just goes to show little we truly know when we go mucking about in the human body.

Depending on how the surgery was done, depending on what other health problems this fella had, depending on a million other factors that none of us know, it's possible that he could have developed a complication like an ileus, or developed adhesions (scar tissue) which cut of the blood supply which could have led to the problem and his subsequent death; however, I've cared for patients for whom this happened and it's very painful. It seems odd to me that someone's bowel can die without at least a little bit of inkling that it's going on. One thing to keep in mind, too, is that ileus's, blockages and adhesions can happen after any abdominal surgery -- including cesarean sections, which now comprise I believe about 25% of births in this country. And if you think they're all necessary for the health of mom and baby, I have a bridge to sell you. ;)

I wish we all went into any kind of medical intervention with full knowledge and informed consent. However, I see so often this almost pathological need to put blinders on. I see it in patients when discussing circumcision for their baby boys, or surgical birth, or weight loss surgery, or even hormonal contraceptives. I guess we just don't like to think that it could happen to us. But sad stories like this show that there truly is no such thing as a free lunch.

[Sandie_Zitkus]

WEll Vickie - without sounding snotty because I do respect your opinion on such things - I don't buy it.

How can you bypass a huge amount of Bowel and just leave it in your abdomen to sit and incubate bacteria without expecting consequences?

Years ago I did an interview with Karen Smith from New Mexico (who has sice passed away from complications from WLS. And in that interview one of the most disturbing side effects she experienced was the puss filled pimple breakouts she would get from time to time all over her body from the bacteria overgrowth that was going on in her bypassed bowel. It still makes we queasy to think about.

If the bowel is fine after bypassing then why is it the surgery is rarely - if ever - reversed? I only know of one woman who has had it reversed and that was because they bypassed too much bowel and she was starving to death. They reversed the surgery and she went right back up to 500 lbs.

But then again you know how I feel about WLS.:(

In a healthy individual, the intestines shouldn't die from being bypassed, because they're still getting a blood supply. That's like saying that a man's scrotum would die from a vasectomy. Yikes! Or that once a woman has a tubal ligation, her fallopian tubes will die. They don't, although they have noticed unexpected changes in women's cycles after tubal ligation, which just goes to show little we truly know when we go mucking about in the human body.

Depending on how the surgery was done, depending on what other health problems this fella had, depending on a million other factors that none of us know, it's possible that he could have developed a complication like an ileus, or developed adhesions (scar tissue) which cut of the blood supply which could have led to the problem and his subsequent death; however, I've cared for patients for whom this happened and it's very painful. It seems odd to me that someone's bowel can die without at least a little bit of inkling that it's going on. One thing to keep in mind, too, is that ileus's, blockages and adhesions can happen after any abdominal surgery -- including cesarean sections, which now comprise I believe about 25% of births in this country. And if you think they're all necessary for the health of mom and baby, I have a bridge to sell you. ;)

I wish we all went into any kind of medical intervention with full knowledge and informed consent. However, I see so often this almost pathological need to put blinders on. I see it in patients when discussing circumcision for their baby boys, or surgical birth, or weight loss surgery, or even hormonal contraceptives. I guess we just don't like to think that it could happen to us. But sad stories like this show that there truly is no such thing as a free lunch.

[Seth Warren]

To make this operation truly reversible, one would need to be able to grow a new intestinal tract; in other words: stem cell research. And even then, we may not be able to do anything like that for decades at the very least.

It seems medically irresponsible to leave a bypassed mass of intestines (which, let's face it, constitutes much more tissue than in a vasectomy) inside of the human body. Perhaps a supply of nutrients can be maintained to what is now a forced vestigial organ. Still, as was mentioned above, what about mass infection? No, if one is intent on having it cut out, then it should be cut out completely so that the "spoil" doesn't cause additional complications.

[Miss Vickie]

Hi Sandie,

Real quick because I'm late for a holiday party but I wanted to respond. You make a good point about the bacteria in the gut, and yes, that would certainly be an issue if it continued to colonize. However, the bacteria grows in response to food; specifically, the food we eat. If it is robbed of its food supply, my guess -- and really, what we know of how the small intestine operates is in its infancy, so I don't think we can say for sure -- is that it stops growing. That's why eating sugar can be so bad for you if you have systemic yeast; you're feeding the bacteria, and since yeast and things love sugar, you're preferentially feeding them, which is what allows an overgrowth of the nasties that make us so sick. I'm not saying its without consequences; just as with reproductive organs, there very clearly could be consequences. However, if the bowel is dead, and sitting in there, you'd be quite sick. If any part of the body is dead and still within the body, the body will see it as a foreign intruder and launch an immunological response.

Specifically to answer your other questions (and forgive the cut and paste nature of this post):

"Years ago I did an interview with Karen Smith from New Mexico (who has sice passed away from complications from WLS. And in that interview one of the most disturbing side effects she experienced was the puss filled pimple breakouts she would get from time to time all over her body from the bacteria overgrowth that was going on in her bypassed bowel. It still makes we queasy to think about. "

That's really disturbing. And I've never heard of that before, and I wonder how an infection in the bowel could spread to the skin without someone becoming septic (a condition that is often fatal). I can say this, though. That the breakouts I used to get as a fat woman are GONE. As is my Rosacea. As is my acne. As is the hyperlipidemia and high levels of homocysteine and CRP which are markers for heart disease. And my blood pressure is normal. As is my insulin level for the first time since I've started having it tested. Given my family history of heart disease and diabetes, for me it was a lifesaver.

"If the bowel is fine after bypassing then why is it the surgery is rarely - if ever - reversed? I only know of one woman who has had it reversed and that was because they bypassed too much bowel and she was starving to death. They reversed the surgery and she went right back up to 500 lbs. "

It's rarely done for lots of reasons. 1) Maybe in most cases it is a success, so why reverse it? 2) Reversing any surgery is always more difficult and dangerous. Why are vasectomies and tubal ligations rarely reversed? Because reconnecting the long-disconnected vessels and nerves is hard and requires a greater level of skill than just cutting them. 3) In the case of the stomach being a muscle, I'm not sure how conducive it would be to reconnection. That being said, I'm guessing that since more and more people are having the surgery, more people will need it reversed, and we'll see an increase in reversals in the future.

"But then again you know how I feel about WLS. "

That's okay. You know how I feel about WLS. But even more importantly, I think you know how I feel about immobility, which is where I was headed. After spending upwards of $30k on a nursing career and following my bliss, how do you think it sat with me that I would be very unlikely to follow that career path, given how things were going? Not to mention the breathing problems I was experience. Strangely, I was blaming them on my Sarcoidosis; however, since the surgery they're all but gone.

Strange things, our bodies are.

Look, I'm not saying it's a perfect wonderful surgery that everyone should have. Hardly. And I'm experiencing some minor, treatable complications right now. But making inflammatory, scary statements basically making it out to be a death sentence is no different or better than what "they" do about being fat. (I'm not saying you're doing this, but I see it a lot in the SA community, statements made that have no basis in truth or even biology).

The truth is that there are down sides to BOTH, to being fat, and to having the surgery. Each person has to decide where they draw the line, what they're willing to tolerate, and what they're willing to do about it. And I think we ought to respect each other's choices in the matter. (Again, not saying you are, but that we all need to -- me, included).

Yikes. I'm late. I hope this is clear. If I've hopelessly muddled it, please be gentle with me. I'm pulled in ten different directions and now I have to go get my ski bunny daughter.

[Wayne_Zitkus]

I learned from another article that Mr. Collins was involved with a bariatric surgeon, acting as a paid employee. With that level of access to a pool of knowledge, how could his condition degrade so far? Was it complacency or neglect on his part or someone else's?
I believe that anyone who has had WLS and is a paid employee of a bariatric butcher needs to state so up front - there's a lot of difference in how people receive a message between when they think the message is voluntarily delivered, and when someone is paid to present a particular viewpoint.

[Miss Vickie]

It's odd. I'd never heard of him before so if he's a paid spokesman or some sort of champion for WLS, I never got the message.

I read the information from his daughter about how he died, and as I figured, he had a bowel obstruction. They aren't terribly common but they are a side effect of any kind of abdominal surgery and can happen even years out. That's why people who have had WLS should take seriously any abdominal pain and get to the doctor immediately. I think many WLS patients become complacent after the first year or so; I certainly hope I won't be one of them, although given my nature as a worry wort, I probably won't.

Very likely his bowel died because of the obstruction, which can cause a twisting of the bowel which cuts off circulation to the area. And obstructions can happen because of adhesions (scar tissue) which develop as the result of any surgical procedure. I'm not sure we can say there was neglect, since it's hard to say how long this went on, whether he told his doctor, etc.

I just hope for him the risks were worth it and that the seven years he had of quality of life made up for the ultimate shortening of his life from the surgery.

[HereticFA]

Sandi, I want to comment on one thing you posted:

"Years ago I did an interview with Karen Smith from New Mexico (who has sice passed away from complications from WLS. And in that interview one of the most disturbing side effects she experienced was the puss filled pimple breakouts she would get from time to time all over her body from the bacteria overgrowth that was going on in her bypassed bowel. It still makes we queasy to think about."

Despite info floating around the fat acceptance community, Karen's death was due to ovarian cancer. There is absolutely no doubt about that. The only relationship to her WLS was that she had become so accustomed to abdominal pains related to her wls that she overlooked other possible causes. She sufered from the "blind loop syndrome" that is associated with the outdated WLS procedure that was performed on her (I believe it was the JIB). The procedure bypasses a section of the intestine which was left as a "blind loop" where colonies of bacteria were able to bloom and eventually cross into the bloodstream with the eruption of pimples Karen told you about. It also can cause severe immune system problems, which I believe Karen also had.

Near the end, Karen was in the hospital for nearly a week trying to find out the cause of her most recent severe abdominals pains. After checking her out all of her GI tract and finding nothing, they expanded the range of their search and found the cancerous ovarian tumor. She died about a week and a half later. She was truly a wonderful person and her death was a major loss to our community.

It's that recurrent issue with abdominal pain and near blockages of the intestine that may be the reason behind Mr. Collins' death. If he had developed a habit of waiting out the pain of any recurrent intestinal "problems", he may have missed the window of opportunity to remove the necrotic portion of his colon while it still involved only a small length.

To answer your question:

"What happend to the intestines that are bypassed and left in the abdominal cavity?"

One of the supposed benefits of the current RNY procedure is the elimination of the blind loop syndrome presented by older procedures like the JIB. By reattaching the lower end of the upper portion of the intestine no longer in the food path to the side of the intestine still in the food path, various gastric fluids (including the all important intrinsic factor) are allowed to drain into the remainder of the usual digestive path. This supposedly prevents the blind loop syndrome where entrapped bacteria bloom unchecked and eventually cross into the bloodstream to cause new problems like the eruption of pimples described by Karen. Of course, that attachment point creates an additional opportunity for adhesions and scar tissue.

This is different from the BPD procedure where the bypassed portion of the GI tract is removed entirely and disposed as medical waste.

[Sandie_Zitkus]

Thanks for that Correction Ray - I had no idea that was what happened. It's still very sad. :(



Sandi, I want to comment on one thing you posted:



Despite info floating around the fat acceptance community, Karen's death was due to ovarian cancer. There is absolutely no doubt about that. The only relationship to her WLS was that she had become so accustomed to abdominal pains related to her wls that she overlooked other possible causes. She sufered from the "blind loop syndrome" that is associated with the outdated WLS procedure that was performed on her (I believe it was the JIB). The procedure bypasses a section of the intestine which was left as a "blind loop" where colonies of bacteria were able to bloom and eventually cross into the bloodstream with the eruption of pimples Karen told you about. It also can cause severe immune system problems, which I believe Karen also had.

Near the end, Karen was in the hospital for nearly a week trying to find out the cause of her most recent severe abdominals pains. After checking her out all of her GI tract and finding nothing, they expanded the range of their search and found the cancerous ovarian tumor. She died about a week and a half later. She was truly a wonderful person and her death was a major loss to our community.

It's that recurrent issue with abdominal pain and near blockages of the intestine that may be the reason behind Mr. Collins' death. If he had developed a habit of waiting out the pain of any recurrent intestinal "problems", he may have missed the window of opportunity to remove the necrotic portion of his colon while it still involved only a small length.

To answer your question:



One of the supposed benefits of the current RNY procedure is the elimination of the blind loop syndrome presented by older procedures like the JIB. By reattaching the lower end of the upper portion of the intestine no longer in the food path to the side of the intestine still in the food path, various gastric fluids (including the all important intrinsic factor) are allowed to drain into the remainder of the usual digestive path. This supposedly prevents the blind loop syndrome where entrapped bacteria bloom unchecked and eventually cross into the bloodstream to cause new problems like the eruption of pimples described by Karen. Of course, that attachment point creates an additional opportunity for adhesions and scar tissue.

This is different from the BPD procedure where the bypassed portion of the GI tract is removed entirely and disposed as medical waste.

[Sandie_Zitkus]

Hey Vickie,

Thank you for this post. I respect your opinion - but I just don't believe hacking up my intestines is going to do anything good for me right now or in the long run. But I wish you luck and health Vickie and I hope it all does what you hope it will. Only YOU can measure *success* of the surgery you had. :)

Happy Holidays to you and Burt and the kids! Wayne and I miss Burt's posts.


Hi Sandie,

Real quick because I'm late for a holiday party but I wanted to respond. You make a good point about the bacteria in the gut, and yes, that would certainly be an issue if it continued to colonize. However, the bacteria grows in response to food; specifically, the food we eat. If it is robbed of its food supply, my guess -- and really, what we know of how the small intestine operates is in its infancy, so I don't think we can say for sure -- is that it stops growing. That's why eating sugar can be so bad for you if you have systemic yeast; you're feeding the bacteria, and since yeast and things love sugar, you're preferentially feeding them, which is what allows an overgrowth of the nasties that make us so sick. I'm not saying its without consequences; just as with reproductive organs, there very clearly could be consequences. However, if the bowel is dead, and sitting in there, you'd be quite sick. If any part of the body is dead and still within the body, the body will see it as a foreign intruder and launch an immunological response.

Specifically to answer your other questions (and forgive the cut and paste nature of this post):

"Years ago I did an interview with Karen Smith from New Mexico (who has sice passed away from complications from WLS. And in that interview one of the most disturbing side effects she experienced was the puss filled pimple breakouts she would get from time to time all over her body from the bacteria overgrowth that was going on in her bypassed bowel. It still makes we queasy to think about. "

That's really disturbing. And I've never heard of that before, and I wonder how an infection in the bowel could spread to the skin without someone becoming septic (a condition that is often fatal). I can say this, though. That the breakouts I used to get as a fat woman are GONE. As is my Rosacea. As is my acne. As is the hyperlipidemia and high levels of homocysteine and CRP which are markers for heart disease. And my blood pressure is normal. As is my insulin level for the first time since I've started having it tested. Given my family history of heart disease and diabetes, for me it was a lifesaver.

"If the bowel is fine after bypassing then why is it the surgery is rarely - if ever - reversed? I only know of one woman who has had it reversed and that was because they bypassed too much bowel and she was starving to death. They reversed the surgery and she went right back up to 500 lbs. "

It's rarely done for lots of reasons. 1) Maybe in most cases it is a success, so why reverse it? 2) Reversing any surgery is always more difficult and dangerous. Why are vasectomies and tubal ligations rarely reversed? Because reconnecting the long-disconnected vessels and nerves is hard and requires a greater level of skill than just cutting them. 3) In the case of the stomach being a muscle, I'm not sure how conducive it would be to reconnection. That being said, I'm guessing that since more and more people are having the surgery, more people will need it reversed, and we'll see an increase in reversals in the future.

"But then again you know how I feel about WLS. "

That's okay. You know how I feel about WLS. But even more importantly, I think you know how I feel about immobility, which is where I was headed. After spending upwards of $30k on a nursing career and following my bliss, how do you think it sat with me that I would be very unlikely to follow that career path, given how things were going? Not to mention the breathing problems I was experience. Strangely, I was blaming them on my Sarcoidosis; however, since the surgery they're all but gone.

Strange things, our bodies are.

Look, I'm not saying it's a perfect wonderful surgery that everyone should have. Hardly. And I'm experiencing some minor, treatable complications right now. But making inflammatory, scary statements basically making it out to be a death sentence is no different or better than what "they" do about being fat. (I'm not saying you're doing this, but I see it a lot in the SA community, statements made that have no basis in truth or even biology).

The truth is that there are down sides to BOTH, to being fat, and to having the surgery. Each person has to decide where they draw the line, what they're willing to tolerate, and what they're willing to do about it. And I think we ought to respect each other's choices in the matter. (Again, not saying you are, but that we all need to -- me, included).

Yikes. I'm late. I hope this is clear. If I've hopelessly muddled it, please be gentle with me. I'm pulled in ten different directions and now I have to go get my ski bunny daughter.

[Miss Vickie]

Thanks, Sandie. Yes for me it was a good thing; only an individual can determine whether it's a good surgery for them. Given the attempts I'd made to lose weight over the years that resulted in minimal, if any weight loss, I felt I had to take the drastic step, given the number of comorbidities that were starting to stack up, and my increasing lack of mobility despite my efforts to stay active. And living where I live, my options were limited (I think I would have preferred to have the lap band).

I guess we'll see in the long run whether it was a good choice. But the quality of life improvement I've seen since the surgery so far have made me think that it's worth it.

And how sad that someone became so "at home" with abdominal pain that they missed having cancer. I can't imagine living like that. I have absolutely no pain, and haven't since the surgery healed in April. I don't throw up, I don't have diarrhea. I have an absolutely normal bowel pattern and in fact I often forget I've had the surgery unless I eat too quickly or too much when I get a momentary "catch", where I get a sensation of food stuck in my chest for a minute or so. I can breathe through it, and if I drink a little water it goes away quicker; it's annoying, but I see it as my body's way of saying, "Hey idiot! Remember that surgery you had? Hello???" That's the closest I get to any discomfort whatsoever. Last night we went to a party and I ate the very same food that the other guests ate except in smaller amounts. I even had wine with dinner and later some cake and coffee (this may explain why I'm losing weight so slowly, eh?) But I know my experiences certainly don't apply to everyone; I just sometimes take exception to the "you'll never be able to eat..." stuff that I hear.

Right now my biggest complication is some wacky blood values which actually predated the surgery. I'm anemic, which is less than fun (and a long term condition for me), and my calcium levels are off (possibly related to the Sarcoidosis). Neither is helped by the malabsorption of the surgery, but we're working on fixing the problems. It's just frustrating knowing that the high doses of nutrients I'm taking probably aren't being absorbed; however, I've read some research recently about intestinal hyperplasia and how the small bowel will regenerate and uptake of nutrients does improve over time. (Our bodies are smart, aren't they?) I hope that, along with the steps I'm taking, will help the situation. Frankly? It's scary, even though I'm not in any real danger from it.

I hope you guys are having a lovely holiday season (though I know it can be stressful). I'll pass along to Burt what you said about his posts; I'm sure he'll appreciate it. :) He's been so busy with work and the school and keeping me in line that he doesn't have many chances to play online anymore.

[HereticFA]

I believe that anyone who has had WLS and is a paid employee of a bariatric butcher needs to state so up front - there's a lot of difference in how people receive a message between when they think the message is voluntarily delivered, and when someone is paid to present a particular viewpoint.

I finally relocated the article where it's stated he was employed by the doctor:
http://www.kristv.com/global/story.asp?s=4150279

"He even became employed by the doctor who operated on him."

The part that concerns me is: "We last caught up with Willie Collins in March. He was active, felt fine and ate only moderate amounts of food over our lunch at one of his favorite places to eat, Kiko's Mexican Restaurant." To be feeling fine but die only eight months later is worrisome.

With the more recent study about the much higher mortality rates of older males who have WLS, I'm wondering if we will see a similar higher mortality rate for those who are several years post-op like Mr. Collins. The body undergoes so many changes as part of the normal aging process, maybe an impaired GI tract causes new & significant problems that the body can't compensate for with degraded nutrient absorbtion during the aging process.

Maybe Mr. Collins ate at Kiko's Mexican Resturaunt a little too often. With a degraded digestive process, he would have had trouble with most of the high fat offerings (assuming classic Tex-Mex, since it was near San Antonio, TX.) Even with small portions, it would still be hard to digest. especially with no gall bladder. That could certainly lead to an intestinal blockage. Of course, with WLS everyone's food intolerances and health issues are different.

[HereticFA]

In a healthy individual, the intestines shouldn't die from being bypassed, because they're still getting a blood supply.

One thing I've wondered about is what really happens to the vagus nerve when they transect the upper fundus with the newer staplers.

If the vagus nerve is impaired, the muscles comprising the intestines would probably atrophy over a several year period and likely lead to intestinal stasis, an issue reported to be experienced by RNY post-ops. Of course, intestinal stasis would certainly lead to intestinal blockage like Mr. Collins encountered.

[Wayne_Zitkus]

The part that concerns me is: To be feeling fine but die only eight months later is worrisome.
Not necessarily. Thinking back, both of my parents were fine eight months before they died. A lot can happen to a person's system in that time.

But I still can't fathom the family's belief that this man's death was completely unrelated to the WLS.

[Miss Vickie]

One thing I've wondered about is what really happens to the vagus nerve when they transect the upper fundus with the newer staplers.

If the vagus nerve is impaired, the muscles comprising the intestines would probably atrophy over a several year period and likely lead to intestinal stasis, an issue reported to be experienced by RNY post-ops. Of course, intestinal stasis would certainly lead to intestinal blockage like Mr. Collins encountered.

Good question. I can't imagine that the vagus nerve is routinely transected since it is responsible for so many bodily functions (like the parasympathetic response in the heart). Here's a wikipedia article about the many functions of this important nerve: http://en.wikipedia.org/wiki/Vagus_nerve I think we'd see a lot more problems with everything from speech to heart rate regulation if the nerve were damaged on a regular basis.

Also, I did a quick google on small bowel regeneration and there were some interesting articles about what happens after the intestine is bypassed and/or resected (whether for WLS, Crohn's or other bowel problems). Over time the intestinal mucosa undergoes hyperplasia, which makes the villi larger, allowing them greater surface area for absorption. (This may explain in part why people regain their weight post WLS). Further, peristalsis, the movement of food through the intestines through rhythmic muscle contractions, slows down, allowing a longer transit time for food (and greater absorption of nutrients and calories). This peristalsis, however, has a downside, and could -- I would imagine -- lead to problems with bowel obstructions down the line. If you already have an adhesion, as an example, which causes a little kink in a bowel, and then the whole activity slows down, the likelihood that you could have a back up increases. Once you have a blockage, it's very difficult to treat without medical attention. Also, people can have blockages and still pass small amounts of stool, which I fear may give some a false sense of security.

In short, once you have WLS you're never out of the woods. Those of us who have it would do well to remember that we are forever changed on the inside as well as the outside and to take any kind of pain seriously.