Surgical Management of Gastro–Gastric Fistula After Divided Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity |
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Authors: | O N Tucker S Szomstein R J Rosenthal |
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Institution: | (1) The Bariatric Institute and Division of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA |
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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.
This paper was presented at the SSAT Poster Presentation session on May 21st 2007 at the SSAT Annual Meeting at Digestive
Disease Week, Washington (poster ID M1590). |
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Keywords: | Complications Roux-en-Y gastric bypass Morbid obesity Fistula Remnant gastrectomy |
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