What to do with my dislocated port? More options!

by Christine on March 5th, 2011

filed under Christine's Life Updates, Gastric Banding Surgery

Yesterday I had a meeting with my gastric banding surgeon, Doctor P. It was a great meeting!

First, I gave him that Thank You card that I made, and I think he liked it. (I think it flustered him a bit!) I am extremely grateful for Doctor P’s help in getting me to a healthy weight for the first time in my life. I tried so hard to lose weight the normal way (aka: eat right, eat less, exercise more) with continual non-success. I really believe I could not have lost the weight if not for the surgery and thus Doctor P’s help. I am very grateful. Very.

Doctor P

Me with Doctor P!

Then I asked Doctor P for a little fill…just a tiny little one. He obliged my request but not without a long lecture about “Maintenance Mode” and the danger of following a number on the scale too closely. Doctor P recommended using the number on the scale as a general guideline: if the number increases, rather than running for a fill every time, I should ask myself, “Why did that number go up?” and then reverse whatever it is that I did.  Still, he gave me less than 0.25 ccs in my band (I apparently have something like 8.5 ccs in my band, for those that care) but man, I sure can feel it! It’s very tight, but it feels good. I will have to remember to chew my food really well for the next few weeks.

Doctor P asked me if I would mind getting in touch with their patient manager, perhaps to be used as a “successful patient” case to show off. I was flattered!  Then his assistant Kim, who is awesome and totally sweet, asked if I would mind coming to a few support group meetings to answer questions and talk a bit about my own experience. I can’t wait to do this!  Again, I was flattered that they would want me to participate.

Lastly, Doctor P and I had a little conversation about my protruding, dislocated port site. (My original post about my port site, from May 2010, is here, with photos.)  For those unfamiliar with the components of the surgery, a description + photos of the port can be found here. The last time we met, Doctor P seemed to recommend taking the port off entirely and putting a plug into the end of the hose. (read about that post here.)  That means that anytime I wanted a fill or unfill, they would actually have to make an incision into my skin in order to find the end of the hose, which would understandably be a big to-do. However, I’m very uncomfortable with that scenario; after all, I went in yesterday for a small fill. I had this HUGE surgery because I liked the idea of having a way to keep my weight in check, forever. I fully intend to use the gastric band in order to maintain my weight, and if you take the port off, that takes away my control over my body, my band’s control over my weight. No, I don’t like that option at all.

Well, Doctor P threw three more options at me. Before I get into it, here are a few photos of the abdominal muscles.

Option 1: Re-attach the port site to the outside of the abdominal wall, as it was supposed to be originally. The good side of this is that it’s the least invasive and probably the easiest surgery to achieve.  The downside is: (1) if the port came off once, it might come off again, and (2) even though the Realize Band has the thinnest port of all the gastric banding brands (it’s nearly twice as thin as the Lap Band port!), it will still be seen under the skin. Doctor P was still concerned about it eroding through my skin, since I don’t have a huge layer of fat under my skin to protect it from popping through.

Option2: Attach the port UNDER my abs. He said that has performed this version four times in the past: all four times have been with male patients. He said that men typically carry their fat UNDER their abs, whereas women typically carry it between the abs and skin. Therefore, he put the port under the abdominal wall because it would be less likely to be noticed and wouldn’t erode through the skin. However, he said in two of those four cases he ended up having to do another surgery and move the port to above the abdomen. The reason for that is because (1) the abominal tissue is extremely tough and tends to clog up the needle used to inject saline into the port, and (2) the abs scar pretty badly, making it really tough to poke through. I have to imagine that finding the port would also be hard, so it would end up being a lot of poking & jabbing with the needle until you found the right spot. That sounds hugely painful, doesn’t it?  I am not sure that I like Option 2 at all. It freaks me out!

Option 3: Doctor P thinks it would be possible to cut a small hole into the abdominal muscle and actually EMBED the port into my abs. That way it would still be easily accessible from the outside, but it would be more flush with the skin and not noticeable. It would not cause erosion through the skin this way. My surgeon has never personally done this before, and he said he would call around to other surgeons to see if they have heard of doing such a thing. I like this option a lot, but I have concerns about whether this will limit my range of movement & muscle capability in my abs (Doctor P says it wouldn’t but how could it NOT?) plus I’m concerned about how painful that surgery must me and the healing time to go with it. Still, I think I like Option 3 best, in addition with Option 1 (which I agree is perhaps not the best long-term solution).

So I have three options on the table. Which one makes the most sense to you? Which would you choose?

I have another appointment with another surgeon next week, so I’ll get someone else’s opinion at that time.  It seems like a big enough decision and a big enough surgery that I wouldn’t mind getting another opinion about my options. This is by no means a reflection of Doctor P, though.  He’s been nothing but totally awesome through this whole process, and I really appreciated him giving me more options yesterday.  He has given me personal attention and personal care through the whole process (he even does my fills himself, rather than having an assistant do it), which is definitely something unique to my gastric banding experience.

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