I'm a 52 year old woman, I had my first colonoscopy a few weeks ago. A large 4cm walnut shaped polyp with a thick stalk was found in the distal sigmoid, about 30cm from the anus. It was biopsied but was too large to remove during the colonoscopy. The biopsied part of the polyp came back negative for cancer, I also had a CT scan and CEA blood test which both came back fine. I'm awaiting an appointment date with a specialist at University of Chicago. I'm not at all sure how they are going to proceed until I meet with the doctor there. The waiting is killing me! I can't concentrate on anything, I'm one of those people who wants to know everything about something that is wrong with me, yet I can't find specific info on this. Does anyone have any comments as to whether or not a specialist might be able to take this out via another colonoscopy or is it more likely I will have to have surgery? And if surgery, is this a hard, difficult surgery to get thru? I hear that it is and I'm very frightened and wondering if it can't be removed thru another colonoscopy by a specialist what are my chances of having it removed laparascopically? Is the location of the polyp a dangerous or difficult location to get to? It's in the turn of the sigmoid colon about 30cm from the anus. I am just so worried and hate playing the waiting game. Any comments would be greatly appreciated! Please help me understand all of this, thank you!

Grechen:
GREAT NEWS on the biopsy results being negative... now you just need to get it removed so it doesn't interfere with the passage of stool and cause an obstruction. I'm guessing your GI wasn't sure whether it WAS cancerous when s/he was in there and opted NOT to take it out for fear it was cancerous and was growing into the wall of your colon.

There REALLY should be NO reason to resect your entire bowel wall for a 4cm polyp. If necessary, they can use a snare to take a couple pieces before removing it in one full swoop. 4cm really is not THAT large for him/her to not be able to remove via a scope. Unless it had an INCREDIBLE blood supply which is doubtful...and if it did, I would have it re-biopsied because that's not the norm. So, the fact that you had a negative pathology report, negative CEA, and negative CT scan, I wouldn't worry and would FULLY expect them to remove it via a scope. So, you will have to prep again, :dizzy: but at least you're not dealing with cancer.

Take Care. Please let us know how it goes.:)

Regards,
CancerDad :angel:

Thank you soooo much for your response, Cancer Dad, I had read many of your posts here, you offer so much to everyone here, I intend to keep coming back here. The GI who did my colonoscopy did remove a small polyp I had but said that this larger one is too large to remove. She was not from U of Chicago, she is a local doctor here in Valparaiso, Indiana. She said the stalk was too thick for her to remove. Then after I wrote my post here I wrote to a clinic in Pa. who specializes in Endoscopes and Colonoscopies. A doctor wrote me back saying that some large polyps with thick stalks have a fat vessei in the stalk that pumps blood, he said he would not attempt to take out the polyp via colonoscopy because of the chance of not being able to stop the bleeding. He said he refers his patients with such to a laparascopic surgeon there in Pa. I have contacted U of Chicago and waiting for an appointment date with a doctor there. This doctor is a specialist in Endoscopy and Colonoscopy, referred to me by another doctor there who specializes in Laparascopic Surgery IF this this doctor cannot help me. Cancer Dad, do you still feel like it might be possible to remove this polyp via Colonscopy rather than surgery, especially since this is a Specialist in this field and not just a regular GI doctor? I am sooo anxious to get this taken care of and just hate the waiting, I want to have it taken out YESTERDAY! I was scheduled to have BPD/DS Weight loss surgery on Sept. 26th and had to postpone it due to this polyp issue. Then I saw another surgeon here who said it could be taken out first at the BPD/DS surgery, it not cancerous proceed onto the rest of the surgery, if cancerous don't proceed with the Weight loss surgery. So my Weight loss surgeon confered with 2 colorectal surgeons in his area and they both felt absolutely not, to have this taken care of first and after healing, then have the weight loss surgery. So here I am waiting and trying to speculate what will happen. Cancer Dad, if there is a large blood supply in this stalk is that a dangerous thing, like something unheard of and very uncommon? From what you know if I would have to have surgery does this kind of stalk make it much more dangerous?
have you ever heard of anyone with this type doing fine during and after surgery? Do you think I would need a resection? Please share more of your knowledge with me. I am very, very worried. Thank you for sharing so far what you know. I really appreciate it!

Hi again:

OK, as I said in my other post, unless there were a major blood supply.... then they wouldn't just automatically remove it. So, at this point, I would go in for additional opinions. With the other surgery you plan to have, I am assuming that your criteria match the other surgery and you are at HIGH risk for ANY other surgical procedure. 50cm is pretty far in for them to do this transrectally without a scope. However, the GI surgeons at U of C MUST have scopes that will allow them to operate through to 1) carefully remove and cauterize the vessel/s, or 2) suture/tie off the stalk in a ligature style to prevent hemmorage when removing the stalk and entire polyp.

I don't know if I, personally, would put my body through a resection... unless the GI Specialist Surgeon plans to do a Laparoscopy from your abdomen/pelvic area, take down the vessels and polyp from the outer wall of your colon, and sew you back up. Hear them out, seek a couple of opinions... and ask questions similar to my concerns. Also, if your local GI who did the initial colonoscopy is new, maybe a more experienced colorectal surgeon, or GI at U of C will want to rescope and see if s/he would attempt to remove. You can have a study done to SEE exactly the blood supply going to that polyp. eg., a trans rectal ultrasound or even a CT scan.

If your BPD Surgeon is in agreement with you having "plan A" paragraph 1 above, then I would go for that-- to tie it off and if necessary have a further procedure when less risky a good year after your BPD (laparoscopically as I stated).

On another note, may I ask WHY you are having BPD as oposed to RGB (Rou en Y Gastric Bypass)? Is your BMI 50 or greater? BPD is a very complicated procedure and not many surgeons offer it, or are properly trained in doing it. I'm sure you must have checked his/her success rates and how many BPD procedures s/he have done. But, I don't mean to be nosy, and you don't have to answer, I am just curious as to why you opted for the more risky and difficult procedure. Also, if you are comfortable saying, may I ask who your surgeon is?

I hope all this makes sense... I have to run. But PLEASE Post back and let us know of your decision.

GOOD LUCK! :)

Warm Regards,
CancerDad :angel:

Hello Cancer Dad, The Bariatric Surgeon I have selected is Dr. Hares in Michigan. I've researched BPD/DS for 5 months and decided it is the procedure for me, my surgeon feels this must definately wait til polyp issue is resolved. I'm not confering with him now about this, he wants it taken care of here & advised me to U of C along doctor here who did my Colonoscopy. He IS very much interested in my outcome but he isn't involved in my treatment for it as he consulted with 2 colorectal surgeons there who both felt it should only be taken care of here. In 1990 I had an Adjustable gastric banding surgery, did very well with it for 5 years until the band broke during a bout of vomiting from flu. Since then I've regained like so many morbidly obese patients do. I never thought of any more WLSweight until this year having had several heart tests run because I was diagnosed with severe sleep apnea and wanted peace of mind of knowing my heart was ok. All tests were fine but I broke down in front of my cardiologist about my not being able to lose and maintain & and my struggle with watching my dad suffer from Alzhemiers. He suggested I look into BPD/DS. I had never heard of it but was miserable enough with myself to look into it. Slowly but surely over literally hundreds of hours, at least 5 hours a day for past 5 months of research I decided it was the surgery for me. Yes, it is more complex, yes fewer surgeons are capable of doing it, yes it requires much more skill. From all of my research I feel statistics for it for overall weight loss AND maintenance are better than RNY. Also from the forums I participate in, I feel the quality of life is much better with BPD/DS than with RNY. I understand I will have to be extremely vigilant about taking vitamins and supplements for the rest of my life and continually monitor blood levels. I am vigilant about taking all my medications and know that I can comply with vitamin regimen as since I first started my research I have been taking them also, several a day along with my medicines. For me, I feel this way, I regained with gastric banding after having maintained for 5years my loss of 80 pounds, I regained after band broke and from what I have read the failure rate of the band is around 30 to 40 percent. Everyone of the people I knew in my support group years ago with the band have regained more than they originally weighed. A revision to DS will have to be done as an open surgery also, and even tho it would be nice to be able to have it done laparoscopically there is something to be said for my surgeon to be able to get in there and see all of my abdomen so even tho I know recovery will be longer I am comfortable with that because I know a revision is a more difficult surgery, altho there is no sign of any damage done by erosion of the band or anything according to the endoscope I had done.

Sorry to be so long winded on this, I'M very excited about the BPD/DS, I have always had a weight problem, My BMI is 41, the BPD/DS used to be done on more heavy weights than myself, but from my research it is being done now also on the lighter BMI's due to its success with more % of weight loss, less regain statistics AND less post op complications. I know many people who have had RNY and are still substantially overweight or regaining. I figure if I am putting my body thru major surgery I want what has the best statistics, the best possibility for me to keep weight off. Also I'm not comfortable with having pyloric valve bypassed with RNY and don't like the idea of having a blind stomach and possibility of stoma obstruction from a man made opening and possibility of ulcers in blind stomach. If RNY were my only option, personally I would NOT have it, I know some folks are doing fine with it but I have read too many who aren't, too many in my opinion are going back for obstructions, or strictures or regaining, or always dumping, I'm just not comfortable with the problems so many seem to be having with it. I know several RNYers who didn't even know they should be taking vitamins! And I've heard over and over again from so many who are so happy with their decision to have BPD/DS about the overrating of bathroom issues with BPD/DS. I feel BPD/DS patients are the most happiest with surgery and quality of their lives. I've traveled to meet people who have had it, one was just revised from RNY to BPD/DS and she looked amazing, she had her revision in San Fran 6 weeks ago, Dr. Husted, and I mean she looked amazing even with an open incision she was healing wonderfully and up and all over the place. I know losing weight requires a lifestyle change, WLS is NOT the easy way out not by a long shot,traveling, 10 day hotel stay to recover before I come home, will all COST me, lost time at work, etc. I also know everyone has to make their own choice. I feel I will be the one who has to live with it, I want what has been proven to be the best possible procedure.
I feel most surgeons do not WANT to take the time to learn the DS because it does take much longer to learn, the RNY can be learned in a 4 hour seminar the DS requires much more skill and time to learn and much more experience. Surgeons who cannot do the DS of course will knock DS, they will sell what they can perform, nevermind there might be a road less traveled that just may be a better option. There was a news report on Channel 2 with MaryAnn Childers about 3 week ago about BPD/DS being proven to be more successful than RNY. Even so, I don't like to take anyone's word for it without doing my own research and so, I have, it's been my mission to become as educated as I can about it and not take it lightly. I search for the good AND the bad, I search DEEP for the bad, I WANT to know what COULD happen. I HAVE read s horror stories about it, but actually very few. I know if vitamin levels are not monitored FOR LIFE, results of this surgery can be devastating. Those who will not comply have NO business even considering the DS and in my opinion the RNY neither.

I have always done remarkably well with any surgery I've had, I know this one could go wrong. I'm going to take the chance that I will be successful with DS as so many are. One thing I've noticed repeatedly is that I've not read one story of someone being revised from a failed BPD/DS to lap band or RNY but have read countless stories of folks being or wanting to be revised from a failed RNY or lapband to BPD/DS. If I'm going to be cut wide open I want the best, if I fail and don't maintain at least I'll know I tried to regain my health with the best procedure out there and failed again. I'll not put myself thru another WLS if this one fails or if I fail it. I've thought long and hard over this and am at peace. This is partly why this polyp issue is so upsetting. I was packed, all ready for my trip to Michigan and all set to be off work and now this. But I must keep my faith and be strong and get thru this. Should something go wrong with this polyp issue and affect my health I will not go thru with BPD/DS on top of any complications that can't be resolved with this polyp. Right now polyp issue is priority. I want to go into BPD/DS in the best health possible so this must be resolved first. If I am advised at U of C NOT to have BPD/DS because of something with my colon I WILL take that advise & NOT have it. I truly hope I have helped answer your questions or curiosity about my selection of weight loss surgery. I truly feel sorry for those who jump into WLS and don't research their options. Many put more research into buying a new car than they do WLS they choose yet they will have to live with effects of that surgery for rest of their lives.
The surgeon I've selected has done over 500 procedures, comes very highly recommended by several people I've met and was trained by Dr. Hess in Ohio who revised BPD/DS to help eliminate some problems with it years ago. To tell the truth I had such a hard time finding his office (I drove there alone)...when I finally got there I sat in my car weeping I was so stressed from trying to find it on time....I sat there thinking I WANT this surgery but I'm so stressed, it's too much of a drive, I can't have it here, BUT since I'm here I'll go in & talk to him. Well, I went in, was overwhelmed at the caring attitude of EVERYONE, patients waiting, ALL the sharing of experiences. ALL were sooo very happy regardless if they had a complication or not, all said they would do it all over in a heartbeat, their quality of life had changed so much. I was filling out paperwork but couldn't concentrate as they were all so willingly sharing their stories. Then I was called in to talk to the surgeon and his nurse. Dr.Hares and Jackie, well...I was immediately extremely impressed with the time they took with me, their concern, their willingness to take their time answering any questions I had. Right then and there I realized I made it there I could make it again for surgery, I was where I needed to be. From then on they have been there every step of the way in figuring out this whole polyp ordeal. They are praying for me and staying in touch with me every week until this is resolved. I feel I am in wonderful hands and I respect Dr. Hares even more for consulting with 2 Colorectal Surgeons there and not just taking the word of a specialist here that I saw telling me to just have them take out the polyp as if it would be no problem at all. Sorry I've gone on and on, I hope I don't get kicked off this board for writing off topic. Thank you for your help I look forward to hearing more from you!

Grechen:
THANK YOU for sharing so much about your thought process regarding your bariatric experiences. UNFORTUNATELY, RNY has gotten a bad name because surgeons think they CAN JUST GO TO A 4HR seminar and lab, and then are able to do the procedure. The procedure requires a significant commitment on the part of the surgeon and hospital-- the surgeon to realize that there is a TREMENDOUS learning curve, and that SOME surgeons just are NOT cut out to do the procedure... surgeons tend to be cocky and don't want to admit that they are incapable of performing the procedure... I used to be in cadaver labs with some of them and try to discourage them because their skill level was JUST NOT THERE. RNY CAN be a great procedure for many people whose surgeons know what they are doing, have an ENTIRE PROGRAM set up, including not only ALL THAT IS NECESSARY for evaluation PRIOR to surgery, but for them to recognize that THIS IS A LIFETIME commitment for patient and surgeon. It requires tremendous follow-up.

Also, patients who don't take it seriously as a LIFE CHANGING EVENT run into problems when they learn they can cheat the procedure with high calorie shakes, etc. And the patients who DON'T know about vitamin requirements, etc., I BLAME the surgeon and the program for this inadequacy. Some surgeons like to jump on the "bandwagon" of what's hot, and do NOT realize the commitment. And like I said above, they simply DON'T learn or have the skills to learn how big the pouch should be... how long the bypass, etc. They want the money and REALLY don't care about the patient... IT'S SAD.

I AM SO HAPPY FOR YOU, that you have taken the initiative to learn as much as you can prior to your procedure. And having it open is fine... most patients end up with an abdominoplasty after they lose the weight anyway, and have all this excess skin, so many times they meet the criteria insurance wise to get this done as well. But the serious people realize this is NOT so you can be a size 0 model... rather it's a LAST RESORT to IMPROVE YOUR OVERALL HEALTH... hypertension, hyperlipidemia, diabetes, etc. SO MANY people are off their medications within a month of the procedure.

So, THANK YOU FOR SHARING. It Really sounds as though you have done your homework and are ready and have reasonable expectations. I WISH YOU THE BEST OF LUCK!!!! :angel:

I am certain you will get this polyp situation straightened out and be on your way. Please keep in touch and let me know how you do with the surgeries. :)

Warm Regards,
CancerDad :angel:

Hello again, Cancer Dad, you are most welcome, it was great to be able to share my thoughts on all of this, so thank YOU for asking and giving me the opportunity to write out my thoughts. It was good therapy for me! :)

I plan to visit this board ALOT now, I most likely will become addicted to it as I am my WLS board. To me this kind of addiction is a good thing because I love learning, especially things that really interest me. And now, your posts have got my interest so I fully intend to try and find some beginning somewhere to your posts and read up on YOU so that I have an idea of what you are or have been dealing with yourself. I read a few of your posts to others questions and problems but didn't see yours but only because yesterday was my first day here. I want to spend time tomorrow reading more about your situation. And so, having said that you will see me hanging around here and I will certainly be posting my progress here and learning more of your history here so that perhaps I can be of some support here for you just as you have been for me. Thank you much for that, I am more afraid of this polyp thing and what it might involve than I am of WLS. Many times I sit here just shaking with fear, that's why I searched the net for a place to go. I found this board, thank you for sharing here, I GREATLY appreciate it and will keep coming back, thank you, thank you, thank you!

Hello again, CancerDad, wondering when you have time could you elaborate on your comments about transrectally removing this polyp, to be honest
I am lost on all this and wondering if you can further explain a bit. Also, the polyp is 30cm proximal to anus, not 50. Does this make removing it any easier or more difficult? I know you are not a specialist but I already value your opinion. Do you really think it's possible I really don't have much to worry about especially if inside the polyp checks out non cancerous? Do you feel U of C will very possibly be able to remove it via colonoscopy or do you feel more likely it will be removed "transrectally" (I'm not sure what you mean by this but do you mean with no incision thru the anus? Or do you feel it will probably require a major surgery? Please share more of your feelings on this, I am still so worried and just hope they get me in and get this over with, it's driving me crazy with worry! Thanks for any more comments, thanks sooo much!

Hello again, CancerDad, wondering when you have time could you elaborate on your comments about transrectally removing this polyp, to be honest
I am lost on all this and wondering if you can further explain a bit. Also, the polyp is 30cm proximal to anus, not 50. Does this make removing it any easier or more difficult? I know you are not a specialist but I already value your opinion. Do you really think it's possible I really don't have much to worry about especially if inside the polyp checks out non cancerous? Do you feel U of C will very possibly be able to remove it via colonoscopy or do you feel more likely it will be removed "transrectally" (I'm not sure what you mean by this but do you mean with no incision thru the anus? Or do you feel it will probably require a major surgery? Please share more of your feelings on this, I am still so worried and just hope they get me in and get this over with, it's driving me crazy with worry! Thanks for any more comments, thanks sooo much!

Hi Grechen: :wave:
I'm glad you asked me to clarify if I didn't explain well enough the first time around. I DEFINITELY think it's possible for them to remove that polyp transrectally. By "transrectal" I mean through the rectum or anus, as opposed to having laparoscopic surgery, which is where they operate through your abdomen and access the colon from the other side through an incision in your "tummy" or abdomen. If they recommend something even MORE invasive like cutting you open and transecting or cutting out the piece of your colon that contains the polyp, then I would DEFINITELY get another opinion. Since this is not cancerous and relatively close to the anal opening, there really is NO reason why they can't attempt removal through your anus.

As I said, I DO think they can do this through your anus by working through a colonoscope using cautery (electrical current used to cut tissue AND to stop bleeding) or tying a loop of suture around the base of the stalk... again, using a colonoscope to tie off any blood supply so they can just cut out the polyp.

If they can't remove it using a colonoscope, then YES, it makes a HECK of a difference that the polyp is 30 cm from the anus. This SHOULD give a colorectal surgeon enough room to use something LIKE a speculum (the device used to hold open your vagina during a Pap smear) to hold open your anus just enough to insert instruments and remove this thing while using cautery or tying off the blood supply and then cutting the polyp out. You WILL be asleep, so your muscles will be relaxed and it shouldn't be a problem, as long as the polyp is within reach of instruments inserted into your anus for removal (they do have longer instruments, so I can't IMAGINE this can't be done). This approach is sometimes used for low grade (stage 1 or possibly 2) cancerous growths as well, so it's NOT like they have never done this.

I hope this makes sense. GOOD LUCK. Please keep us posted!:)

Fondly,
CancerDad:angel:

Cancer Dad, thanks so very much for clarifying this for me. Just so I know I am understanding this correct, transrectally removing the polyp means the same thing as removing it via colonoscopy except with different tools?? Am I understanding this correctly? Sorry I'm such a pain I just really want to understand it correctly. In the report from the colonoscopy it states the polyp was 4cm and was too large to fully photograph, and was in the turn of the distal sigmoid, I think I forgot to mention that, does that make a difference as far as difficulty? I can tell by the way you write you definetely have ALOT of education and experience with this kind of stuff, I think it is absolutely wonderful that all you have gone thru and you are offering so much knowledge to everyone here. You certainly have to be one heck of a man and even tho I just found this board just a couple days ago, I thank you so much for all of your help here. What a comfort I have found here just in what you have wrote and your opinions. I am more worried about this than I am the Weight loss surgery, I am at peace with it, but this...I don't know a thing about it other than what you have shared with me so I want to make sure I understand it correctly. I am praying that tomorrow at work I will get a phone call from U of C with an appointment date, all they are waiting for is the referral from the doctor who did the colonoscopy and I've already contacted them with a reminder to please send it. I paln to keep coming back here, now I am becoming obsessed with this colon stuff, actually it's very interesting. May I ask are you in the medical field at all or did you just obtain all of your knowledge by going thru so much yourself? I wish you the very best, you certainly deserve it, what a strong man you are and so very, very giving. Thank you!