Ricard Corcelles1, Mohammad H Jamal2, Christopher R Daigle3, Tomasz Rogula3, Stacy A Brethauer4, Philip R Schauer3. 1. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Fundació Clínic per la Recerca Biomèdica. Hospital Clínic of Barcelona, Universitat de Barcelona, Spain. 2. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Surgery, Kuwait University, Kuwait. 3. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA. 4. Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: BRETHAS@ccf.org.
Abstract
BACKGROUND: Gastrogastric fistula (GGF) is a rare complication after Roux-en-Y gastric bypass (RYGB) that can be challenging to treat. OBJECTIVE: The aim of this study is to examine our surgical experience in the management of GGF after RYGB. SETTING: Academic center, United States. METHODS: We report a consecutive series of 36 patients who underwent surgery for GGF at our institution between 2005 and 2013. RESULTS: The cohort had a mean age of 48.0±10.8 years, mean body mass index (BMI) of 34.6±11.3 kg/m(2), and an average number of 5.0±2.0 co-morbidities at the time of GGF revision. Of the 36 patients, 16 (44.4%) had previous open RYGB. Endoscopy confirmed GGF in 26 patients (72.2%), whereas upper gastrointestinal (GI) series indicated GGF in 21 of 30 cases (70.0%). The GGF surgery was on average 6.4±3.8 years after the primary procedure. All patients underwent surgical management either in the form of a redo gastrojejunal anastomosis with excision of fistula (77.7%) or a remnant gastrectomy with excision of fistula (22.2%). Mean operative time, blood loss, and length of stay were 248.4±103.3 minutes, 232.7±270.2 mL, and 8.5±8.6 days, respectively. One major intraoperative and 6 early postoperative complications occurred. After a mean follow-up of 38.4±30.0 months, the mean BMI was 35.5±6.2 kg/m(2) in patients with weight regain before GGF revision (P<.05) versus 25.0±6.1 kg/m(2) in patients without weight regain (P = .7). CONCLUSION: GGF is a rare complication of RYGB. Surgical treatment should be tailored to the presenting symptoms and associated anatomic abnormality. Anastomotic revisions are associated with higher complication rates.
BACKGROUND:Gastrogastric fistula (GGF) is a rare complication after Roux-en-Y gastric bypass (RYGB) that can be challenging to treat. OBJECTIVE: The aim of this study is to examine our surgical experience in the management of GGF after RYGB. SETTING: Academic center, United States. METHODS: We report a consecutive series of 36 patients who underwent surgery for GGF at our institution between 2005 and 2013. RESULTS: The cohort had a mean age of 48.0±10.8 years, mean body mass index (BMI) of 34.6±11.3 kg/m(2), and an average number of 5.0±2.0 co-morbidities at the time of GGF revision. Of the 36 patients, 16 (44.4%) had previous open RYGB. Endoscopy confirmed GGF in 26 patients (72.2%), whereas upper gastrointestinal (GI) series indicated GGF in 21 of 30 cases (70.0%). The GGF surgery was on average 6.4±3.8 years after the primary procedure. All patients underwent surgical management either in the form of a redo gastrojejunal anastomosis with excision of fistula (77.7%) or a remnant gastrectomy with excision of fistula (22.2%). Mean operative time, blood loss, and length of stay were 248.4±103.3 minutes, 232.7±270.2 mL, and 8.5±8.6 days, respectively. One major intraoperative and 6 early postoperative complications occurred. After a mean follow-up of 38.4±30.0 months, the mean BMI was 35.5±6.2 kg/m(2) in patients with weight regain before GGF revision (P<.05) versus 25.0±6.1 kg/m(2) in patients without weight regain (P = .7). CONCLUSION: GGF is a rare complication of RYGB. Surgical treatment should be tailored to the presenting symptoms and associated anatomic abnormality. Anastomotic revisions are associated with higher complication rates.