Obesity Surgery

, Volume 28, Issue 4, pp 939–944 | Cite as

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

  • Elias Chahine
  • Radwan Kassir
  • Mazen Dirani
  • Saadeddine Joumaa
  • Tarek Debs
  • Elie Chouillard
Original Contributions

Abstract

Background

Gastrogastric fistula (GGF) occurs in 1–6% of patients who undergo Roux-en-Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer.

Objectives

The purposes of the study are to describe the principles of management and to review the literature of this uncommon complication.

Setting

The setting of this study is University Hospital, France.

Materials and Methods

We conducted a retrospective review of all patients’ records with a diagnosis of GGF after RYGB between January 2004 and November 2014.

Results

During the study period, 1273 patients had RYGB for morbid obesity. Fifteen patients presented with a symptomatic GGF (1.18%). The average interval from surgery to presentation was 28 months (22–62). A history of marginal ulcer or anastomotic leak was present in nine patients (60%). The most common presentation was weight regain (80%), followed by pain (73.3%). Two types of fistulas were identified, an exclusively GGF (high) and a gastro-jejuno-gastric fistula (low). High GGF, frequently associated with dilatation of the gastric pouch, was treated by a sleeve of the pouch and sleeve resection of the remnant stomach (nine patients). Low GGF was treated with gastric resection coupled with a revision of the gastrojejunal anastomosis (six patients). All patients were treated laparoscopically with no conversion to laparotomy. The average length of postoperative hospital stay was 5.2 days (range 3–10).

Conclusion

GGF after RYGB is a rare complication. Its pathophysiology remains unclear. Surgical management is the definitive treatment.

Keywords

Gastrogastric fistula Gastric bypass Marginal ulcer Fistula Bariatric Obesity Laparoscopy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of General and Minimally Invasive SurgeryParis Poissy Medical CenterPoissyFrance
  2. 2.Department of General Surgery, CHU Nord HospitalJean Monnet UniversitySaint EtienneFrance
  3. 3.Department of General SurgeryCHU ArchetNiceFrance

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