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

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. The purposes of the study are to describe the principles of management and to review the literature of this uncommon complication. The setting of this study is University Hospital, France. We conducted a retrospective review of all patients' records with a diagnosis of GGF after RYGB between January 2004 and November 2014. 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). GGF after RYGB is a rare complication. Its pathophysiology remains unclear. Surgical management is the definitive treatment.