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Surgical Endoscopy

, Volume 23, Issue 11, pp 2591–2595 | Cite as

Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula

  • Jayaraj Salimath
  • Raul J. RosenthalEmail author
  • Samuel Szomstein
Dynamic Manuscript

Abstract

Background

Gastrogastric fistula (GGF) is a rare complication after divided Roux-en-Y gastric bypass (RYGBP). The incidence can be as high as 49% in patients who undergo nondivided or partially divided RYGBP. We have previously reported a GGF rate of 1.5% after divided RYGBP. Remnant gastrectomy has been advocated by our group as a treatment option for this complication. We report our initial experience using the laparoscopic approach.

Methods

After IRB approval and following HIPAA guidelines, we conducted a retrospective review of prospectively collected database of 1,796 patients who underwent RYGB from 2001 and to 2008 at the Bariatric and Metabolic Institute. Data included mean time to laparoscopic remnant gastrectomy (LRG), mean length of hospital stay, follow-up period after laparoscopic remnant gastrectomy, rate of conversion, type of procedure performed, and early and late postoperative complications.

Results

Twenty-one (1.1%) patients have been diagnosed with GGF; 11 more patients were admitted with GGF after undergoing initial RYGB at another institution. All patients (n = 32) were initially treated with sucralfate and proton pump inhibitors, and 22 of 32 patients eventually underwent LRG: 1 underwent fistulectomy, 1 underwent conversion of vertical banded gastroplasty to RYGB, and the remaining 8 patients have undergone only medical treatment. The mean time to LRG was 9 months from the time of diagnosis of GGF. Two of the 22 patients had conversion to an open approach: one because of a loss of poor visual surgical field resulting from excessive intraluminal air from intraoperative endoscopy and the other as a result of the inability to understand the anatomy laparoscopically. Three of the 22 patients (13%) underwent LRG and redo gastrojejunostomy because of a stenosed gastrojejunostomy. The mean hospital stay after LRG was 4.7 (range, 3–8) days. Early postoperative complications included intra-abdominal bleeding, pneumonia, wound infections, and fever of unknown origin. Late complications included intra-abdominal abscess, wound infections, fever, and food impactation. The follow-up period after LRG was an average of 4 (range, 1–11) months. During the follow-up period, there was no evidence of marginal ulceration, bleeding, abdominal pain, or recurrence of the GGF in any patient.

Conclusions

Laparoscopic remnant gastrectomy seems to be a safe and effective treatment option for patients with GGF after RYGBP.

Keywords

Methylene Blue Gastric Pouch Gastroesophageal Junction Sucralfate Remnant Stomach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

(AVI 1005051 kb)

References

  1. 1.
    Capella JF, Capella RF (1999) Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction. Obes Surg 9:22–27CrossRefPubMedGoogle Scholar
  2. 2.
    Carrodeguas L, Szomstein S, Soto F et al (2005) Management of gastrogastric fistula after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1292 consecutive patients and review of literature. Surg Obes Relat Dis 1:467–474CrossRefPubMedGoogle Scholar
  3. 3.
    Cho M, Kaidar-Person O, Szomstein S, Rosenthal R (2007) Laparoscopic remnant gastrectomy: a novel approach to gastrogastric fistula after Roux-en-Y gastric bypass for morbid obesity. J Am Coll Surg 204:617–624CrossRefPubMedGoogle Scholar
  4. 4.
    Cucchi SG, Pories WJ, MacDonald KG et al (1995) Gastrogastric fistulas. A complication of divided gastric bypass surgery. Ann Surg 221:387–391CrossRefPubMedGoogle Scholar
  5. 5.
    MacLean LD, Rhode BM, Nohr C et al (1997) Stromal ulcer after gastric bypass. J Am Coll Surg 185:1–7CrossRefPubMedGoogle Scholar
  6. 6.
    Gustavsson S, Sundbom M (2003) Excellent weight results after Roux-en-Y gastric bypass in spite of gastro-gastric fistula. Obes Surg 13:457–459CrossRefPubMedGoogle Scholar
  7. 7.
    Sapala JA, Wood MH, Sapala MA et al (1998) Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 8:505–516CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jayaraj Salimath
    • 1
  • Raul J. Rosenthal
    • 1
    Email author
  • Samuel Szomstein
    • 1
  1. 1.The Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic SurgeryCleveland Clinic FloridaWestonUSA

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