Question:
Had an Upper GI that showed a fistula.... 22 months post-op... what now?

I've read through all of the posts regarding fistulas in the library, but one thing I haven't noticed is anyone not gaining weight after they discovered that they have a fistula. For those that do not know, a fistula is a tube that grows between one organ and another. I have had a fistula grow between my pouch and my old stomach. I had the Upper GI because I was having severe pain and bloating, that hurt so bad that I could barely stand up for 6-8 hours at a time (about twice per month). As I was having the test, it was obvious that a small amount of barium was going into the old stomach. According to my doctor, I am transected, so before now, I never thought that this was possible. So far, I have gained no weight, and the only problem is the periodic pain that I am experiencing. My surgeon doesn't seem to think that my pain has anything to do with the fistula, but according to all that I have read, my people develop ulcers in the pouch due to stomach acid coming up through the fistula and irritating the pouch. I know that there are medicines that they can give you to elevate ulcer pain, but if there is a chance of weight gain associated with the fistula, I am really scared. Has anyone lived with a fistula and now experienced weight gain? I hate the thought of another surgery, especially since I have already been through an RNY and abdominoplasty in the past 22 months. If it is necessary, I will do it, but it is still a little scary. It is weird that the body will try SO hard to normalize that it GROWS a tube to the old stomach. Anyone have any input?    — Lori B. (posted on May 11, 2003)

May 11, 2003
http://groups.yahoo.com/group/Graduate-OSSG Sit on this list awhile & when you feel comfy, ask about fistulas. Several people are living with them, but at a higher wt than they'd want. I don't have one (don'; have lower stomach), but the thought woudl scare me. I had SLD and the acid coming up did hurt, did form another marginal ulcer. I used Prilosec 40mg X 4 per day and Carrafate at night to quiet the burning. I also went to 6 or more protein shakes a day to hold my weight down & keep peace in the acid factory. I managed to only regain 12# in the 4 month Insurance Nightmare. My heart is with you, thru the fears, the pain & hopefully, a revision
   — vitalady

May 11, 2003
when I read your question, I had to answer. I too had a fistula develop. Only it developed 2 months after my surgery. I had a very difficult recovery. The surgeon told me that I needed surgery and I didn't want to do it. I tried to live with it until this past summer. Ever since that time, I had severe pain. I decided to have a revision as I gained almost every pound back and I did it in 3 months. I truly understand the complaint of severe abdominal pain. I have been living it for almost a year along with severe gastritis. It will not heal itself but it is up to you if you want to live with it or not.
   — Cher W.

June 3, 2003
I feel for you, I also have a fistula of the stomach and i'm over 1 1/2 years out and have gained 35 pounds back so far. I have alot of stomach pains and really gassy (Not sure if this has to do with fistula but this is what i'm dealing with ). I have to live with it because I do not have any insurance except Medicaid and in my state they will NOT cover any type of weight loss surgeries. I am sad and angry, I did everything right and did not gorge or anything and this happens..
   — Michelle G.

August 27, 2003
I had the Roux En Y divided gastric bypass surgery on January 18th 2002 which is now just a few days over a year and half ago. Since that time I have lost approximately 200 pounds, which is roughly, 11 pounds a month, which is not the expectation, I had set for myself. Part of the problem I have encountered I will be having surgery to correct. On June 26th I had a visit with my surgeon Dr, Eric Bour. I explained to the Doctor I had been throwing up within the past week every time I would eat a normal meal like 1 - 2 oz of grilled chicken and maybe 1 oz of mashed potatoes and 1 or 2 cubes of fruit. Also for at least two months prior to this I was hurting when trying to eat after a bite or two. After explaining this to the doctor he decided to do and Endoscopy (EDG) to see if I had a stricture in the pouch (the new stomach) which is like a closure or narrowing of the exit for my new stomach. What they found was in fact much more serious. I had developed a fistula between my pouch (new stomach) and the old stomach. Now this is a rare occurrence or complication of the Roux En Y divided Gastric Bypass surgery and happens in less than 2% of patients. The "WHY?" of how this happened is not definite but could have occurred due to a small staple line disruption that attached itself to the old stomach which after surgery lies adjacent to but disconnected from the new pouch. This would have occurred over a period of time but in conjunction with a stricture on the other side of the pouch would have caused a fistula to form, which creates an opening between the pouch and the old stomach. Now this is just a possible reason for the fistula that developed and I have included a link with an article that also provides other information regarding this complication and other complications. Click here: http://www.usagiedu.com/articles/barsur/barsur.pdf I asked the doctor if I did something wrong to have caused this and his answer was NO, however I do believe had I paid more attention to the warning signs of a problem, it could have been detected sooner. I can't change what has happened and now begins the task to correct the problem. The surgeon has ordered a series of Endoscopies (4 to be exact) to attempt to open the stricture at the bottom of the pouch by dilating the pouch with a balloon and wire. This needs to be done first so the surgery to repair the fistula can be done successfully. The EDG's are to take place on the following dates 7/24 10:00 am, 7/31 10:00 am, 8/6 8:00 am, and 8/13 6:00 am. These are all outpatient procedures and the hope is that the exit of the pouch will be successfully dilated each time and that it will stay open. Next will be the major surgery, which is tentatively scheduled for 8/26 (I will know for sure in a few days what time and where). This is the surgery to actually repair the pouch and detach the fistula.
   — jillygirl

May 28, 2005
I developed a fistula from small pouch to old stomach which was more like a disruption of the staple line. THe small instestine that was hooked to my small pouch came unhooked completely and so the food I ate HAD to go through that tiny fistula or else I would throw it up. I became very malnourished and required a revision surgery. When I had the revision, the surgeon tried to patch the fistula hole. He had to remove part of my stomach becausse of complications. Anyway....that fistula then developed from my pouch to outer abdominal wall. If I took a drink of blue Kool-Aid, you could see blue Kool-aid come outof a hole in my stomach wall. I was on a feeding tube for 3-4 months and was not able to eat or drink anything until that fistula healed. It was very frustrating and difficult but now it has been healed for almost 2 years and i have no problems. The only time I gain weight is when I eat things that are bad for me and don't exerise. Exercise and behavior modification are the only things that will keep any of us WLS patients from gaining back the weight. Be glad that you fistula is just to your old stomach and not to some other organ. Crohn's disease is a disease where patient's have chrnonic fistulas and just have to deal with it.
   — Jayne N.