Fistula after RNY?

Hi, I have a fistula between my pouch and my old stomach.  Its along the staple lines even though the pouch was completely severed from the remaining stomach.  I understand that this is relatively rare, Anyone else have the same experience?  If so, what did you do about it? I have not had pain or other symptoms, I found out during an upper GI while looking into a clinical trial for the RESTORe procedure. I am scheduled to see Dr. Thompson at Brigham & Women's in Boston to see if he can repair the fistula and my enlarged stoma opening endoscopically. Thanks Kathy

Hi I'm from Norwich, CT!!!  I went to see Chris Thompson to see if I qualified for the clinical trial but I didn't because I guess my opening wasn't too big.  I had gastric bypass in 1982 at Hartford Hospital with Philip Trowbridge as my surgeon.  he's probably dead by now.  I would guess that you might not qualify simply because I think the trial is only to close the enlarged stoma, not repair a fistula.  but, good luck anyway!!

Hi, I did qualify due to the size of my stoma, but once they found the fistula, I was an automatic non-qualifier.  However, Dr. Thompson can still go in endoscopically and fix the stoma and the fistula.  I'm looking forward to seeing him again, and getting back on track. Thanks for writing.

Hi Kathy, I was diagnosed with a fistula a few weeks ago and I am going through the pre op testing right now.   I had my original RNY in 1998 and spent years telling the doctor I could eat too much, I was back to my original weight, but over the past 6 or so months I have lost 50 lbs, it has been a real struggle.  My original surgery was open, so my revision will be open with a hernia repair.   I do have stomach pain, but I am not sure if it is the hernias or fistula.  During my UGI the radiologist told me about 75 % of my intestines were in hernias. Good Luck with your revisions and please keep us up to date.  I will do the same. Thanks, Danna

Hi Danna What type of revision are you having?  What type of surgery did you have originally?  I've told my surgeon from almost the beginning that I could eat too much - and now, I can eat more, and am hungry more frequently than pre-op!  Mainly, its because of the size of my stoma, but the fistula has some to do with it as well. Thanks for replying, and I look forward to keeping up with you. Kathy

Kathy:

I had a fistula, along with staple-line disruption and some other stuff.

Dr. Daniel Herron of NYC did my revision.  He is a wonderful, caring physician and I recommend him highly. He had little choice, due to the damage, so he removed my "old" stomach.  Problem fixed. 

Thanks for your reply.  Do you know what caused the fistula?  I'm under the impression that it is very rare to have a fistula and staple-line disruption - in fact, I can't figure out how it can happen, so I'm interested in knowing what you were told.  What were your symptoms, etc? Did you travel from IL to NY to have Dr. Herron?  Which hospital is he with, and which revision type did he do - a DS? I appreciate hearing from you, Kathy

Kathy:

There is no way to know if a person is going to develop a fistula.  It is that individual's own body which determines how "overboard" it's going to go to try to heal the surgery.  If surgeons knew beforehand, they'd try to stop it.  But there is no way to know.

It is indeed rare to have both stape-line disruption and a fistula.  My body pulled out all the stops (it heals itself well).  But in my case, the original surgeon must have got lazy, because he did not use 3 rows of staples, and he did not transect (cut away) the old stomach.  He used one row.  I guess he had a golf tee-off or something.

I went from IL to NYC because no doctor would touch me.  Dr. Herron was doing an investigational study and I consulted him.  I didn't qualify but he said he could fix it.  He did.

I had another RNY revision.  I did not want the DS, and he did only as much as he felt my body could handle.  For instance, he refused to bypass more intestine because the revision was extensive enough he was afraid he'd create more problems by trying that.

Hi Kathy, I wanted to let you know that I saw the surgeon today.  We discussed my fistula repair and the revision options.  He indicated that my orginal surgery from 1998 was similar but not the same as the gastric buypass they do today.  I have the option of having the fisturla repaired which woudl be an open surgery or they could revise what I presently have into a buypass.  The dr indicated that with the buypass I would have a better weight loss success.   They will not know how much of my intestines they will buypass until they see what was previously done.   I also have hernias that I am going to consult a plastic surgeon to determine if they can be repaired during the bariatric surgery.   I am still making my decision regarding the surgery, i am planning on having the surgery in April regardless of what process I decide on. Hope to hear from you soon. Thanks, Danna

Hi Danna, I wondered if you had had the same RNY procedure as I did, because my sister had a stomach stapling before they did RNY's.  She had staple-line disruption and is back to her original weight, I had not heard of this happening to RNY patients except for very rarel I was very pleased with my bypass originally.  It will definately give you restriction (at least at the beginning).  My advice - don't drink diet soda or anything carbonated, and let the ride last as long as possible, i.e., don't eat ANYTHING extra during the "honeymoon" period - take full advantage of what the surgery has for you.   Best wishes to you as you move forward. Kathy