Ulcer & now a Fistula

Hi,

I had RNY 2 1/2 years ago Jan. 2, 2007). November of 2008 I had an EGD & it was discovered that I had a marginal ulcer. I had a follow up EGD this past week, and after 6 months of liquid Carafate 3 times a day and 30mg Prevacid capsules 2 times a day, I still have an ulcer, but through the EGD also discovered that a fistula has formed. I have no pain & feel just fine. I do smoke a pack of cigarettes a day. My surgeon told me to stop smoking, which I'm attempting to do. He wants to do another EGD in another 2 months.  I can't see there being any change in the ulcer or fistula if there hasn't been any improvement in the past 6 months.  Any ideas, suggestions, comments, experiences to share with me? After searching this site, there seems to be experiences of either an ulcer or a fistula but not a combination of the two.  My surgeon did mention something about removing my unused stomach & reconstructing my pouch where the intestine is attached (anasrimosis). Anybody else out there with this issue?

sorry u are going thru so much.  by the way, what is a fistula?

hi vickie. thank you for your thoughts.  a fistula is a hole that has formed between the pouch & the unused stomach.  the acid that caused the ulcer has eaten a hole through the pouch into the unused stomach.  the pouch isn't connected to the unused stomach but the pouch sits on top of the stomach so they touch.  it allows the two to communicate; in effect, food goes into the unused stomach where its not supposed to go & you gain weight. My fistula is small right now & i don;t think any food is getting in, but it will have to be monitored to see if it gets any bigger.

interesting, good luck to you.

Hi Anne,
I had my surgery in Oct. 2004 and have also just found out that I have the same problem, only I didn't know it had a name.  I'm very interested in any information that you or anyone else on this site can offer.  I have an excellent surgeon, but am extremely concerned for my health and need to know what our options are. 

My thoughts and prayers are with you!

Miranda

I have the same problem as you and also looking for information.  My doc also said that i would need to have half of my stomach removed....I'm concerned about the surgery.  Please post any information that you find out and I will do the same.  Good Luck to you and God Bless.

Thanks!
My surgery is scheduled for January 12, 2010.  I have a pre-op consult January 4th & I have a couple of pages of questions to ask my surgeon. After he answers them I'll post the questions & answers as a reply to this post.  Unfortunately this is such a rare condition, to have both an ulcer & fistula there's not much info out there. Good luck to you also & God bless you. You'll be in my thoughts

I had my pre-op consultation with my surgeon today. He's also the same surgeon that did my origonal gastric bypass surgery.  He will be removing 70% of my 'old' stomach for 2 reasons. 1) to prevent another fistula from forming and 2) to reduce the amount of gastric cells that produce acid in the pouch & 'old' stomach. Even though the pouch & old stomach are totally separate, the same nerves control both.  He expects me to be in the hospital 4-5 days. He will also be putting in a G Tube (feeding tube) into the old stomach nub that will be left over after surgery to increase my protein intake to help the healing. He expects to leave that in 4-6 weeks.  I will need to follow the post-operative gastric bypass diet like I did when I originally had surgery; 1st liquids for a couple weeks, then move on to pureed foods, then to mechanical soft foods, etc.

As for a pre-operative diet, I have to drink protein shakes (Liquids) for 3 days prior to surgery to make sure that I have enough protein in my body. Again, that's to help with the healing.  My surgeon is pretty sure that he will be able to do this surgery laparascopically like he did with my initial bypass surgery.  He said the only reason he would have to open me up would be if he accidentally cut my spleen which is connected to the 'old' stomach by ligaments.  But he said that it would be unlikely that it would convert to an open procedure.

One interesting thing that he mentioned to me is that this is considered a revisional surgery.  I always thought that a revisional surgery was redoing the gastric bypass because of insufficient weight loss; but actually any surgery that occurs after the initial gastric bypass is considered revisional, including for the ulcer/fistula problem.  It's just now 6-10 years out that information on revisional surgery is being published, including statistics.  My surgeon said that the continuing education classes that he takes are all about revisional surgery. I think that we will begin to see more data in the years to come as more & more people develop problems that can;t be treated with medicine & require surgery.  Most ulcers heal in 12 weeks with carafate & a proton-pump inhibitor; having a marginal ulcer that doesn;t heal is rare. He also mentioned that it is possible that my ulcer perforated into the 'old' stomach which is what caused the fistula.

As for future health problems or additional supplements or hormones, he said I wouldn't have to take any more supplements than I'm taking now: B-12, Vitamin D, iron/Vitamin C, calcium citrate, and a multi-vitamin. And he said there are no future health problems associated with taking out 70% of the old stomach. 

I hope that this answers your questions & gives others out there with the same issue some guidance.  Please keep me in your thoughts January 12, 2010!