Surgical management of gastrogastric fistula

Affiliations


Abstract

Background: Gastrogastric fistula (GGF) is a rare complication after Roux-en-Y gastric bypass (RYGB) that can be challenging to treat.

Objective: The aim of this study is to examine our surgical experience in the management of GGF after RYGB.

Setting: Academic center, United States.

Methods: We report a consecutive series of 36 patients who underwent surgery for GGF at our institution between 2005 and 2013.

Results: The cohort had a mean age of 48.0±10.8 years, mean body mass index (BMI) of 34.6±11.3 kg/m(2), and an average number of 5.0±2.0 co-morbidities at the time of GGF revision. Of the 36 patients, 16 (44.4%) had previous open RYGB. Endoscopy confirmed GGF in 26 patients (72.2%), whereas upper gastrointestinal (GI) series indicated GGF in 21 of 30 cases (70.0%). The GGF surgery was on average 6.4±3.8 years after the primary procedure. All patients underwent surgical management either in the form of a redo gastrojejunal anastomosis with excision of fistula (77.7%) or a remnant gastrectomy with excision of fistula (22.2%). Mean operative time, blood loss, and length of stay were 248.4±103.3 minutes, 232.7±270.2 mL, and 8.5±8.6 days, respectively. One major intraoperative and 6 early postoperative complications occurred. After a mean follow-up of 38.4±30.0 months, the mean BMI was 35.5±6.2 kg/m(2) in patients with weight regain before GGF revision (P<.05) versus 25.0±6.1 kg/m(2) in patients without weight regain (P = .7).

Conclusion: GGF is a rare complication of RYGB. Surgical treatment should be tailored to the presenting symptoms and associated anatomic abnormality. Anastomotic revisions are associated with higher complication rates.

Keywords: Bariatric surgery; Gastrogastric fistula; Gastrogastric fistula treatment.


Similar articles

Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity.

Cho M, Kaidar-Person O, Szomstein S, Rosenthal RJ.J Am Coll Surg. 2007 Apr;204(4):617-24. doi: 10.1016/j.jamcollsurg.2007.01.054.PMID: 17382221

Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass.

Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP.Surg Obes Relat Dis. 2017 Feb;13(2):243-248. doi: 10.1016/j.soard.2016.09.027. Epub 2016 Sep 28.PMID: 27889483

Surgical Management of Gastrogastric Fistula After Roux-en-Y Gastric Bypass: 10-Year Experience.

Chahine E, Kassir R, Dirani M, Joumaa S, Debs T, Chouillard E.Obes Surg. 2018 Apr;28(4):939-944. doi: 10.1007/s11695-017-2949-2.PMID: 28983751

Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature.

Carrodeguas L, Szomstein S, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP, Villares A, Zundel N, Rosenthal R.Surg Obes Relat Dis. 2005 Sep-Oct;1(5):467-74. doi: 10.1016/j.soard.2005.07.003. Epub 2005 Aug 31.PMID: 16925272 Review.

Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment.

Pauli EM, Beshir H, Mathew A.Curr Gastroenterol Rep. 2014 Sep;16(9):405. doi: 10.1007/s11894-014-0405-1.PMID: 25113040 Review.


References

https://pubmed.ncbi.nlm.nih.gov/