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Erschienen in: Obesity Surgery 4/2018

05.10.2017 | Original Contributions

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

verfasst von: Elias Chahine, Radwan Kassir, Mazen Dirani, Saadeddine Joumaa, Tarek Debs, Elie Chouillard

Erschienen in: Obesity Surgery | Ausgabe 4/2018

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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.
Literatur
1.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
2.
Zurück zum Zitat Capella JF, Capella RF. Staple disruption and marginal ulceration in gastric bypass procedures for weight reduction. Obes Surg. 1996;6(1):44–9.CrossRefPubMed Capella JF, Capella RF. Staple disruption and marginal ulceration in gastric bypass procedures for weight reduction. Obes Surg. 1996;6(1):44–9.CrossRefPubMed
3.
Zurück zum Zitat MacLean LD, Rhode BM, Nohr C, et al. Stomal ulcer after gastric bypass. J Am Coll Surg. 1997;185(1):1–7.CrossRefPubMed MacLean LD, Rhode BM, Nohr C, et al. Stomal ulcer after gastric bypass. J Am Coll Surg. 1997;185(1):1–7.CrossRefPubMed
4.
Zurück zum Zitat 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 28CrossRefPubMed 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 28CrossRefPubMed
5.
Zurück zum Zitat Cucchi SG, Pories WJ, MacDonald KG, et al. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221(4):387–91.CrossRefPubMedPubMedCentral Cucchi SG, Pories WJ, MacDonald KG, et al. Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg. 1995;221(4):387–91.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
7.
Zurück zum Zitat Pauli E, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery—clinical recognition and treatment. Curr Gastroenterol Rep. 2014;16:405.CrossRefPubMed Pauli E, Beshir H, Mathew A. Gastrogastric fistulae following gastric bypass surgery—clinical recognition and treatment. Curr Gastroenterol Rep. 2014;16:405.CrossRefPubMed
8.
Zurück zum Zitat 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.PubMed 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.PubMed
10.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
11.
Zurück zum Zitat Mason EE, Printen KJ, Blommers TJ, et al. Gastric bypass for obesity after ten years experience. Int J Obes. 1978;2:197–206.PubMed Mason EE, Printen KJ, Blommers TJ, et al. Gastric bypass for obesity after ten years experience. Int J Obes. 1978;2:197–206.PubMed
12.
Zurück zum Zitat Obstein KL, Thompson CC. Endoscopy after bariatric surgery (with videos). Gastrointest Endosc. 2009;70(6):1161–6.CrossRefPubMed Obstein KL, Thompson CC. Endoscopy after bariatric surgery (with videos). Gastrointest Endosc. 2009;70(6):1161–6.CrossRefPubMed
13.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
14.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
15.
Zurück zum Zitat Corcelles R, Jamal MH, Daigle CR, et al. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11(6):1227–32.CrossRefPubMed Corcelles R, Jamal MH, Daigle CR, et al. Surgical management of gastrogastric fistula. Surg Obes Relat Dis. 2015;11(6):1227–32.CrossRefPubMed
16.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
17.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
18.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
19.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
20.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
21.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
22.
Zurück zum Zitat 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.CrossRefPubMed 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.CrossRefPubMed
23.
Zurück zum Zitat 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. –72CrossRefPubMedPubMedCentral 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. –72CrossRefPubMedPubMedCentral
Metadaten
Titel
Surgical Management of Gastrogastric Fistula After Roux-en-Y Gastric Bypass: 10-Year Experience
verfasst von
Elias Chahine
Radwan Kassir
Mazen Dirani
Saadeddine Joumaa
Tarek Debs
Elie Chouillard
Publikationsdatum
05.10.2017
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 4/2018
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2949-2

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