Hi All, 

Looking for information from WLS patients that developed a gastric fistula and had it repaired.  My question is were you able to loose the regained weight once the fistula was repaired? Any share is appreciated. Trying to decide if the repair to the fistula along with removing the part of the stomach not used  so I don't feel hunger will be enough. Dr. offered distal revision but I'm already so deficient needing iron transfusions because I don't absorb iron and b12 shots weekly that I' worried about the risks associated with distal.

J.O.

Update

I had the Apollo Overstitch on July 27, 2015. My story is posted under the revision forum titled:

After Apollo Overstitch to correct Gastric Fistula & Reduce Stoma

I had one. I was suffering with bile burning me up from the inside. They don't go away. They have to be surgically corrected.  It will also on get worse.  I had the gastrectomy. I go in for a distal revision in a few weeks.  I was dying from the inside.. Weight loss wasn't a concern for me. I would aspirate bile in my sleep.  It's pretty rare but they are finding it more in long term post ops

Also make sure you have an experienced revision surgeon

Thank you for the reply. Can I asked why you decided to do a distal revision instead of only repairing the fistula? My story is long and complicated, like a lot of us here, and I don't have the energy to type it. I'm going back and forth with the distal decision. The side effects sound real dangerous. I was thinking that after my fistula is reversed and my anatomy is put back how it was suppose to befor the roux n y that I'll start looking weight like I did the first time.

My gastrectomy was done and the fistula was repaired.  Post op it's been discovered that the staples from my original bypass have eroded and my insides look like a ceviche salad.  The bile burns where so bad, the distal for me is more of a salvage surgery. 

May you find much needed relief. I've woke up only a handful of times with my esophagus on fire, moved to my lungs felt like I was dying from acid reflux. I can't imagine how you suffered. Keep us updated if you can. 

I'm NOT speaking from personal experience here. These are conclusions I've come to from reading here and on other bariatric sites for the past 11+ years.

Distal RNYs have been described as being the worst of both the RNY and the DS, meaning that you'd still have all the potential problems of the pouch/stoma combo, plus the increased malabsorption of the DS. You might want to contact Michelle Curan, aka Vitalady. She and her husband are both about 20 years post-op from distal RNYs. There's a reason they're in the vitamin business! (*grin*)

Repairing your fistula *should* result in weight loss, but probably not at the rate at which you lost weight immediately after your original surgery. You don't say how many years post-op you are, but most RNYers no longer have any significant malabsorption of calories going on after about 18-24 months post-op.

Removing your remnant stomach will not ensure that you no longer feel hunger. Repairing the fistula will mean your remnant stomach stops coming in contact with food, and this alone *should* decrease your sensation of hunger some.

The reason you aren't absorbing iron is because your entire duodenum has been bypassed. Revising to a distal RNY wouldn't change this at all. The reason you're not absorbing B12 is because the lower part of your stomach has been bypassed, and that's where intrinsic factor is produced. Without intrinsic factor, you can't absorb B12 from food. Again, revising to a distal RNY and/or removing your remnant stomach won't change this.

Now---something your doctor hasn't mentioned, and most likely does not do, is to revise your RNY to a DS. This would involve sewing your pouch back to your remnant stomach, then forming a gastric Sleeve, then reconfiguring your small intestine to the DS setup. This would do several potentially beneficial things for you.

First, it would repair your fistula. Second, it would give you back a fully-functional stomach, and SOME ability to produce and utilize intrinsic factor. (It would also remove from your body most of the tissue that produces ghrelin, the so-called 'hunger hormone'. Again, this doesn't guarantee you won't feel hunger. Hunger is a natural function, and trust me, you don't want to be without it entirely. It SUCKS to have to force yourself to eat.) Third, it would give you back about half of your duodenum. This may or may not improve your ability to absorb iron, because the duodenum is where most iron absorption occurs. However, it's uncommon for RNYers and, to a lesser extent, DSers to require periodic iron infusions.

And---the DS has the very best long-term, maintained weight-loss stats, period. You don't say how much weight you need to lose, or if you have other co-morbidities. The DS also has the best stats for resolving or preventing things like diabetes and high cholesterol, and it would allow you to once again take NSAIDs for things like arthritis, headaches, fever, aches and pains. It's something to research before you make your final decision.

However, there are only a few surgeons qualified to do the very complicated RNY-to-DS revision, so the odds are good you'll have to change surgeons.

Oh---'DS' stands for Duodenal Switch.

You will gain weight with the fistula. You have a fully functioning stomach now. The food you eat goes from the pouch right into your blind stomach which now is no longer blind. You are absorbing everything you did preop. 

No, Chili, she'd not absorbing everything she did pre-op, because she still has all of her duodenum and some of her ileum bypassed. She *may* be getting all the intrinsic factor now she did pre-op, since she's sending food past the lower stomach.

I had a fistula, a very large one I had zero restriction.  when you can eat to the levels preop, you are absorbing more than if you are only filling a 4 oz pouch. Without feeling full you tend to eat ALOT  more.  I have spoken with 2 seperate respected revision surgeons about this very rare complication  

Please. I am living it.  Not just reading it.