Surgical management of gastrogastric fistula

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. (C) 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.