IS FISTULA CAUSE OF PAIN

Question
I AM A 33 YEAR OLD FEMALE.  I HAD AN OPEN RNY PROCUDURE PERFORMED IN JUNE OF 2005.  I LOST ABOUT 90 LBS AND HAVE REGAINED 40 IN THE PAST YEAR.  I HAVE TO ADMIT THAT I WAS EXERCISING IN A GYM REGULARLY UNTIL I HAD TO RETURN TO WORK A YEAR AGO.  AFTER HAVING UPPER ABDOMINAL PAIN FOR A MONTH, I WENT TO SEE MY SURGEON.  AN UPPER GI SHOWD REFLUX, EARLY ULCER, AND A FISTULA.  I HAVE BEEN TAKING PRILOSEC FOR 10 WEEKS AND DONNATOL AND GAS-X.  THERE WAS A LITTLE IMPROVEMENT AFTER A COUPLE OF WEEKS, BUT NONE SENSE.  I HAVE DAYS WITH ALMOST NO PAIN, AND OTHER DAYES WILL ALL DAY PAIN.  THE PAIN DOES NOT SEEM TO BE TRIGERED BY A CERTAIN FOOD OR DRINK.  MANY DAYS, THE PAIN WILL BE THERE BEFOR I HAVE ANYTHING TO EAT OR DRINK.  MY SURGEON SAID THAT HE DOESN'T KNOW IF MY PROBLEM IS SURGICAL.  HE SAYS THE PAIN COULD BE COMING FROM THE REFLUX, ULCER, OR FISTULA.  HE FEELS THAT ALL THE WEIGHT GAIN IS FROM NOT EXCERSING BECAUSE THE FISTURA HAS ONLY A 1 CM OPENING.  HE SAID THAT HE IS NOT QUALIFIED TO FIX THE FISTULA AND NO OTHER SURGEONS IN THIS AREA ARE EITHER.  HE WANTS TO SEND ME TO ANOTHER DOCTOR BUT DOESN'T KNOW WHERE TO SEND ME.  HIS NURSES HAVE ME CALL WITH AN UPDATE ONCE A WEEK SO THAT THEY STAY ON TOP OF THINGS.  SO MY QUESTIONS ARE, HOW LONG DOES IT TAKE AN ULCER TO HEAL?  CAN THE FISTULA BE CAUSING THE PAIN?  HOW DO YOU FIGURE OUT WHAT'S CAUSING THE PAIN?  HOW LONG SHOULD I WAIT THIS OUT?  HOW DO I FIND A DOCTOR WHO CAN HELP ME?
THANKS,
JENNIFER

Answer
Jennifer,
If I understand correctly, you are asking about a fistula between your stomach pouch and your larger bypassed stomach.  If this is correct, then it is very likely that the fistula IS causing the pain, and that the ulcer will never heal as long as the fistula continues.  Your weight gain is probably not directly related to the ulcer, but it is highly unlikely that you would be able to control weight or lose weight in the context of the pain and the disruptions that the ulcer causes for your eating patterns.

Also, the fistula will NOT heal itself.  It requires surgical repair.

Unfortunately, your surgeon has told you correctly that repair of this type of fistula is very challenging.  In order to find a surgeon likely qualified to handle this problem, you may wish to search on the web for a Center of Excellence at:
http://www.surgicalreview.org/locate.aspx

Be aware that the new surgeon may not be totally happy about taking over from another surgeon who is not willing to handle the long term consequences of his surgery, so you may have a bit of work to do in getting seen.

Best of luck!
Dr JP

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