Background

This is the case of a 58 year old male with who presented to our office as a consult for weight regain twenty years after a history of an open vertical banded gastroplasty. He had an initial weight of 343 lbs and was able to reach a nadir of 275 Ibs. Unfortunately, he had regained approximately 40 lbs to a weight of 312 lbs. He denied any other symptoms, such as reflux, dysphagia, or regurgitation. He did complete a trial of Medical Weight Management but without much of any success. He had a pre-operative endoscopy and upper GI series. The endoscopy showed a small hiatal hernia with no evidence of band or mesh erosion and no evidence of gastrogastric fistula. The upper GI series showed the expected postoperative changes of prior bariatric surgery. During the procedure, as we were making the gastrojejunal anastomosis, we made the intra-operative diagnosis of a gastrogastric fistula. We discovered this after an endoscope was passed into what we thought was an entirely excluded gastric remnant. We proceeded to completely divide the remnant from the pouch. There were no major complications with the procedure. He left on post-operative day 2 after a negative UGIS and he was able to tolerate some liquids by mouth. The patient was seen in clinic about a week postoperatively. He was without any major issues and was tolerating a liquid diet well. The blake drain was removed and continued to follow up with the office regularly.