Background

In this case, patient is a 63-year-old female presenting with dysphagia and abdominal pain (187 lbs, 30.51 kg/m²). The patient’s surgical history includes a primary laparoscopic Roux-en-Y gastric bypass in twenty years prior (260 lbs, 43.30 kg/m²). She then underwent a band over bypass at our facility ten years ago due to weight recidivism (223 lbs, 37.10 kg/m²). She was lost to follow up with nadir weight loss to 2.6% percent excess weight loss. She reported experiencing epigastric pain radiating to the port site, dysphagia, and GERD (gastroesophageal reflux disease) with esophagitis, thus indicating the need for band removal. Upon exploration, the band and buckle were found to have eroded entirely into the gastric pouch lumen with greater than 50% erosion. There were numerous adhesions present around the small bowel. With endoscopy, a guidewire was looped around the band and a lithotripsy device was used to cut band, and was retrieved in entirety through the oropharynx. Repeat endoscopy then found an approximately1 cm gastrogastric fistula that was identified. Due to patient’s weight recidivism likely attributed to the gastrogastric fistula, (220 lbs, 37.76 kg/m²) and worsening GERD symptoms, patient was re-explored with repair of moderate-sized hiatal hernia and resection of the fundus of the remnant stomach along with the fistula. At three weeks post-operative, the patient reported weight loss (204 lbs, 32.93 kg/m²) and resolution of GERD symptoms.