Sorry, Long Post - Gastro Gastric Fistula

Hello

Questions:
1.If a GGF is fixed, is weight loss automatic? I have no desire to lose another pound.
2. What's recovery (open) like?
3. Is revision to VSG possible on the stomach only?


Brief Background:

RNY at 268lbs 12/08
Removal of gall bladder 09/09. I was at my ideal weight...about 145lbs.

Over the past three weeks:
CAT scan w/wo contrast
Upper GI w/contrast
EGD
ER last Saturday...bloody loose stools and vomiting.

I've been on Prevacid Solutabs since surgery and Carafate for six months. I recently started Zofran because even the smell of food makes me sick.

My diagnosis was a fistula. My surgeon thought it was an ulcer. Fistulas for some means weight gain....not me.  Due to the pain and naseau my weight loss has started again.

June 2010 - 122lbs, was told by my surgeon to eat every two hours.
Three weeks ago - 126lbs, was told by my surgeon to work on maintaing and to eat 3-4/day.
Two weeks ago - 128lbs
Today - 120lbs I'm 5'7" and I look and feel like crap.

I meet with my surgeon tomorrow to discuss ALL surgical options. From the nurses (doc was on vacation) surgery will be OPEN and I'll be sent home with a drain for six weeks. When the weight dipped to 122lbs, he told me that I will have to have a feeding tube if I dipped under 120lbs.

Sorry for the looooong post. Any answers/advice will be greatly appreciated!

Speaking from my experience as a surgeon, it sounds like your main issue with your GG-fistula is ulcer/inflammation. The two go together, and not all patients with GG-fistula gain weight. It is not an automatic thing to assume that you will lose weight with getting your fistula closed, especially if it calms down the inflammation in your stomach.
The recovery time depends on your general health and conditioning going into surgery, and on how large an incision your surgeon needs to make. Most often, the hospital stay would be on par with any other open revision involving the stomach, being 3-5 days.
Conversion from your RNY to a sleeve can be done, but the bypass portion of your RNY should be taken down as well, to prevent future ulcer disease from occuring. The main issue with converting RNY pouches to sleeves is that of stricture formation in the sleeve, at the point where the pouch is re-connected to the downstream stomach. This can really slow down the recovery of some patients, and may result in some additional weight loss until the stricture stretches out and the sleeve matures.

Thanks for chiming in, Dr. Husted!!!  Always nice to see you here. 

I appreciate all of the surgeon insight on the RNY pouch takedown!!


Keep popping in!!!
-Jamie