Original articleClassification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass
Section snippets
Methods
From November 2000 to January 2015 all patients who underwent laparoscopic RYGB were entered in a prospective database. After internal review board approval, we retrospectively reviewed data of all patients who were diagnosed with GGF. Data abstracted for analysis included patient characteristics, presenting symptoms, initial diagnostic studies, time from surgery to diagnosis, and time to revisional surgery. Moreover, we retrospectively searched all signs that could be symptomatic of a leak,
Results
During the study period, 1900 consecutive patients underwent divided RYGB; 1890 were completed laparoscopically and 10 converted to open. Nine patients developed a GGF (.5%). Demographic data are detailed in Table 1. Among the patients, one previously smoked, one had previous surgery for craniopharyngioma, and one had been converted to open RYGB. None had had preoperative Helicobacter pylori infection, and none used nonsteroidal anti-inflammatory drugs. One had developed a postoperative gastric
Discussion
In our series of 1900 consecutive patients who had divided RYGB, 9 developed a GGF (.5%), a relatively low incidence compared with others’ series [2], [3], [4]. However, the true incidence in most studies, including our own, are probably underestimated, as asymptomatic patients can achieve good durable weight loss [9], [10], [11]. Pathogenesis of GGF after divided RYGB is not clearly understood. Various causes have been advocated, such as failure of complete gastric transection, foreign body
Conclusion
Gastrogastric fistula is a rare complication after divided RYGB. Weight regain and epigastric pain with or without marginal ulcer are the most common presenting symptoms. Diagnosis can be challenging, but combining UGI endoscopy and contrast study is the best method to confirm the diagnosis. Surgical treatment should be tailored to both location of the GGF and status of the gastrojejunostomy, but anastomotic revision is associated with higher complication rates. GGF classification, based on its
Disclosures
The authors have no commercial associations that might be a conflict of interest in relation to this article.
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