Gastrogastric Fistula after Gastric Bypass – Is Surgery Always Needed?

Because of regain of weight to BMI 37.1 kg/m² 6 years after a VBG, a 41-year-old female now underwent revision to divided Roux-en-Y gastric bypass, performed laparoscopically. 12 days postoperatively, she started bleeding from the main stomach, and CT scan revealed that the bypassed stomach was distended with clot. She was treated conservatively and stopped bleeding. Upper GI series 2 weeks postoperatively revealed a large gastrogastric fistula between the tiny pouch and the bypassed stomach. We initially planned to close the fistula. However, upper GI series 2 months and 4 months postoperatively showed no sign of gastrogastric fistula, and proton pump inhibitors were stopped. At 1 year after gastric bypass, our patient has had good weight loss.