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Journal of Gastrointestinal Surgery

, Volume 11, Issue 12, pp 1673–1679 | Cite as

Surgical Management of Gastro–Gastric Fistula After Divided Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

  • O. N. Tucker
  • S. Szomstein
  • R. J. Rosenthal
Article

Abstract

Background

Gastro–gastric fistula (GGF) formation is uncommon after divided laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. Optimal surgical management remains controversial.

Methods

A retrospective review was performed of a prospectively maintained database of patients undergoing LRYGB from January 2001 to October 2006.

Results

Of 1,763 primary procedures, 27 patients (1.5%) developed a GGF and 10 (37%) resolved with medical management, whereas 17 (63%) required surgical intervention. An additional seven patients requiring surgical intervention for GGF after RYGB were referred from another institution. Indications for surgery included weight regain, recurrent, or non-healing gastrojejunal anastomotic (GJA) ulceration with persistent abdominal pain and/or hemorrhage, and/or recurrent GJA stricture. Remnant gastrectomy with GGF excision or exclusion was performed in 23 patients (96%) with an average in-hospital stay of 7.5 days (range, 3–27). Morbidity in six patients (25%) was caused by pneumonia, n = 2; wound infection, n = 2; staple-line bleed, n = 1; and subcapsular splenic hematoma, n = 1. There were no mortalities. Complete resolution of symptoms and associated ulceration was seen in the majority of patients.

Conclusion

Although uncommon, GGF formation can complicate divided LRYGB. Laparoscopic remnant gastrectomy with fistula excision or exclusion can be used to effectively manage symptomatic patients who fail to respond to conservative measures.

Keywords

Complications Roux-en-Y gastric bypass Morbid obesity Fistula Remnant gastrectomy 

Abbreviations

AA

antecolic antegastric

BMI

body mass index

CT

computed tomography

GE

gastroesophageal

GUGI

gastrograffin upper gastrointestinal study

GGF

gastro–gastric fistula

EGD

Esophagogastroduodenoscopy

LRG

laparoscopic remnant gastrectomy

LRYGB

laparoscopic Roux-en-Y gastric bypass

POD

postoperative day

PPI

proton pump inhibitor

RG

remnant gastrectomy

RR

retrocolic retrogastric

RYGB

Roux-en-Y gastric bypass

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Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  1. 1.The Bariatric Institute and Division of Minimally Invasive Surgery, Cleveland Clinic FloridaWestonUSA

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