Abstract
Gastro-gastric fistula is a complication that might happen after a bariatric procedure like Roux-en-Y gastric bypass. It is defined as an abnormal communication between the excluded gastric pouch and the gastric remnant after gastric bypass. Its incidence has substantially decreased since the technique evolved from a nondivided to a divided gastric pouch. The diagnosis of gastro-gastric fistula could be challenging because of the clinical presentation that varies depending on the etiology, the patient’s objective and subjective response, the time of onset, the medications administered, and the imaging sensitivity. Besides clinical evaluation, imaging studies like upper GI study and CT scan and esophagogastroduodenoscopy are useful tools in achieving a diagnosis. Finally, medical and surgical management are extensively discussed in this chapter.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Switzer NJ, Karmali S, Gill RS, Sherman V. Revisional bariatric surgery. Surg Clin North Am. 2016;96(4):827–42.
Elnahas A, Graybiel K, Farrokhyar F, Gmora S, Anvari M, Hong D. Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc. 2013;27(3):740–5.
Capella JF, Capella RF. Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg. 1999;9(1):22–7. discussion 8
Cucchi SG, Pories WJ, MacDonald KG, Morgan EJ. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221(4):387–91.
Pauli EM, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery-clinical recognition and treatment. Curr Gastroenterol Rep. 2014;16(9):405.
Coblijn UK, Lagarde SM, de Castro SMM, Kuiken SD, van Wagensveld BA. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg. 2015;25(5):805–11.
Cho M, Kaidar-Person O, Szomstein S, Rosenthal RJ. Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg. 2007;204(4):617–24.
Carrodeguas L, Szomstein S, Soto F, et al. 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. Surg Obes Relat Dis. 2005;1(5):467–74.
Yao DC, Stellato TA, Schuster MM, Graf KN, Hallowell PT. Gastrogastric fistula following Roux-en-Y bypass is attributed to both surgical technique and experience. Am J Surg. 2010;199(3):382–5. discussion 5–6
Ribeiro-Parenti L, De Courville G, Daikha A, Arapis K, Chosidow D, Marmuse JP. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2016;
O'Brien CS, Wang G, McGinty J, et al. Effects of gastrogastric fistula repair on weight loss and gut hormone levels. Obes Surg. 2013;23(8):1294–301.
Gustavsson S, Sundbom M. Excellent weight result after Roux-en-Y gastric bypass in spite of gastro-gastric fistula. Obes Surg. 2003;13(3):457–9.
Corcelles R, Jamal MH, Daigle CR, Rogula T, Brethauer SA, Schauer PR. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11(6):1227–32.
Lee SD, Khouzam MN, Kellum JM, et al. Selective, versus routine, upper gastrointestinal series leads to equal morbidity and reduced hospital stay in laparoscopic gastric bypass patients. Surg Obes Relat Dis. 2007;3(4):413–6.
Quartararo G, Facchiano E, Scaringi S, Liscia G, Lucchese M. Upper gastrointestinal series after Roux-en-Y gastric bypass for morbid obesity: effectiveness in leakage detection. A systematic review of the literature. Obes Surg. 2014;24(7):1096–101.
Huang CS, Forse RA, Jacobson BC, Farraye FA. Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery. Gastrointest Endosc. 2003;58(6):859–66.
Gumbs AA, Duffy AJ, Bell RL. Management of gastrogastric fistula after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006;2(2):117–21.
Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011;56(4):931–50.
Filho AJ, Kondo W, Nassif LS, Garcia MJ, Tirapelle Rde A, Dotti CM. Gastrogastric fistula: a possible complication of Roux-en-Y gastric bypass. JSLS. 2006;10(3):326–31.
Salimath J, Rosenthal RJ, Szomstein S. Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula. Surg Endosc. 2009;23(11):2591–5.
Fernandez-Esparrach G, Lautz DB, Thompson CC. Endoscopic repair of gastrogastric fistula after Roux-en-Y gastric bypass: a less-invasive approach. Surg Obes Relat Dis. 2010;6(3):282–8.
Bhardwaj A, Cooney RN, Wehrman A, Rogers AM, Mathew A. Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg. 2010;20(8):1090–5.
Flicker MS, Lautz DB, Thompson CC. Endoscopic management of gastrogastric fistulae does not increase complications at bariatric revision surgery. J Gastrointest Surg. 2011;15(10):1736–42.
Niland B, Brock A. Over-the-scope clip for endoscopic closure of gastrogastric fistulae. Surg Obes Relat Dis. 2017;13(1):15–20.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Giambartolomei, G., Menzo, E.L., Szomstein, S., Rosenthal, R. (2018). Gastro-Gastric Fistula Following Gastric Bypass. In: Camacho, D., Zundel, N. (eds) Complications in Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-75841-1_7
Download citation
DOI: https://doi.org/10.1007/978-3-319-75841-1_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-75840-4
Online ISBN: 978-3-319-75841-1
eBook Packages: MedicineMedicine (R0)