Excellent weight result after Roux-en-Y gastric bypass in spite of gastro-gastric fistula

A male patient (age 37 years, BMI 38 kg/m(2)) underwent a revisional gastric bypass after failed gastric banding. Unfortunately he developed a leak from the proximal pouch and subsequently a gastro-gastric fistula between the pouch and the main stomach. He recovered fully and could eat and drink without any restriction. Repeat examination with x-ray and endoscopy revealed that the fistula remained widely open. Remarkably, the patient lost weight to a BMI of 27 kg/m(2) (ie. lost 80% of his original excess body weight), thus challenging the widely held opinion that gastro-gastric fistulas inevitably lead to poor weight loss. In our patient the weight loss was stable for 2 years, when the fistula was closed surgically to avoid chronic proton pump inhibitor medication for stomal ulcer.