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.
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References
Debs T, Petrucciani N, Kassir R, et al. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005–2014. Surg Obes Relat Dis. 2016;12(8):1602–9.
Capella JF, Capella RF. Staple disruption and marginal ulceration in gastric bypass procedures for weight reduction. Obes Surg. 1996;6(1):44–9.
MacLean LD, Rhode BM, Nohr C, et al. Stomal ulcer after gastric bypass. J Am Coll Surg. 1997;185(1):1–7.
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 28
Cucchi SG, Pories WJ, MacDonald KG, et al. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221(4):387–91.
Schauer PR, Ikramuddin S, Hamad G, et al. Laparoscopic gastric bypass surgery: current technique. J Laparoendosc Adv Surg Tech A. 2003;13(4):229–39.
Pauli E, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery—clinical recognition and treatment. Curr Gastroenterol Rep. 2014;16:405.
Favretti F, Segato G, DeMarchi F, et al. Malfunctioning of linear staplers as a cause of gastro-gastric fistula in vertical gastroplasty. G Chir. 1990;11:157–8.
Ribeiro-Parenti L, De Courville G, Daikha A, et al. Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass. Surg Obes Relat Dis. 2017;13(2):243–8. https://doi.org/10.1016/j.soard.2016.09.027.
Sapala JA, Wood MH, Sapala MA, et al. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg. 1998;8:505–16.
Mason EE, Printen KJ, Blommers TJ, et al. Gastric bypass for obesity after ten years experience. Int J Obes. 1978;2:197–206.
Obstein KL, Thompson CC. Endoscopy after bariatric surgery (with videos). Gastrointest Endosc. 2009;70(6):1161–6.
Lee JK, Van Dam J, Morton JM, et al. Endoscopy is accurate, safe, and effective in the assessment and management of complications following gastric bypass surgery. Am J Gastroenterol. 2009;104(3):575–82.
Huang CS, Forse RA, Jacobsen BC, et al. Endoscopic findings and their clinical correlations in patients with symptoms after gastric bypass surgery. Gastrointest Endosc. 2003;58(6):859–66.
Corcelles R, Jamal MH, Daigle CR, et al. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11(6):1227–32.
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.
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;6:282–8.
Bhardwaj A, Cooney RN, Wehrman A, et al. Endoscopic repair of small symptomatic gastrogastric fistulas after gastric bypass surgery: a single center experience. Obes Surg. 2010;20(8):1090–5.
Gagner M, Gentileschi P, De Csepel J, et al. Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg. 2002;12(2):254–60.
Gibril F, Lindeman RJ, Abou-Saif A, et al. Retained gastric antrum syndrome: a forgotten, treatable cause of refractory peptic ulcer disease. Dig Dis Sci. 2001;46(3):610–7.
Ribeiro-Parenti L, Arapis K, Chosidow D, et al. Comparison of marginal ulcer rates between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2015;25(2):215–21.
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.
O’Brien CS, Wang G, McGinty J, et al. Effects of gastrogastric fistula repair on weight loss and gut hormone levels. Obes Surg. 2013;23:1294–301. –72
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Chahine, E., Kassir, R., Dirani, M. et al. Surgical Management of Gastrogastric Fistula After Roux-en-Y Gastric Bypass: 10-Year Experience. OBES SURG 28, 939–944 (2018). https://doi.org/10.1007/s11695-017-2949-2
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DOI: https://doi.org/10.1007/s11695-017-2949-2