with Dr. Jacques Himpens
Gastro-gastric fistula is an uncommon complication of gastric bypass (both Roux-en-Y and single anastomosis). Its symptoms range from none (if the fistula is small) to severe (if the fistula is significant). Severe symptoms include: invalidating gastroesophageal reflux (GERD), and failure to lose weight. The treatment can be postponed when symptoms are mild, but more often than not, revisional surgery needs to be considered. Despite several isolated reports on success with endoscopic treatment, state-of-the-art treatment currently still consists of (laparoscopic) revisional surgery. This case is the laparoscopic revision of such a gastro-gastric fistula after a Roux-en-Y gastric bypass.
Clinical Case:
Clinical Background
The patient is a 56-year-old man
23.3 kg, 183 cm, BMI 37
Current problem: weight regain, Acid reflux ++
Technique Description
Bariatric History:
2005: Lap gastric banding
2013: Lap conversion to gastric bypass
Other history:
Open appendectomy, hernia repair with mesh, atrial fibrilation (ablation), asthma, gall stones
Co-morbidity: hypertension, refluxoesophagitis, dyspnea, back pain, psychological problems
Medication: PPI 2 x 40 mg/d, Sevikar
Lab: Vit D 16 µg/L
Daily calory intake: 1649 kcal/d
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