Effective Laparoscopic Repair of Gastrogastric Fistula After Laparoscopic Roux-en-Y Gastric Bypass

Abstract

Introduction:

Gastrogastric fistula is a communication between the gastric remnant and the gastric pouch. This type of fistula is a rare complication after a Roux-en-Y gastric bypass (RYGB). These types of fistulas may be caused by an anastomotic leak, marginal ulcers, distal obstruction, or erosion from a foreign body. The type of fistula may also form secondary to an undivided stomach with a subsequent staple line failure.

Case Presentation:

A 50-year-old female who was status post a laparoscopic RYGB at an outside facility in 2010 presented for weight gain. She lost 99 lbs in 2 years after the RYGB but then regained 43 lbs in a couple of months before presentation. At the time of evaluation, the patient's body mass index was 32 kg/m². An upper gastrointestinal swallow study showed a gastrogastric fistula and an endoscopic gastroduodenoscopy documented the communication between the gastric pouch and remnant stomach. The patient underwent an elective laparoscopic repair of the fistula. Intraoperatively, the gastrogastric fistula was confirmed by insufflating air through the gastric pouch while the alimentary limb was clamped. After confirmation, the remnant stomach was mobilized and transected proximally along with the gastrogastric fistula. The gastric pouch and alimentary limb were protected with a Bougie and there was impingement of the conduit. After the procedure, the patient was effectively extubated and discharged on postoperative day 2. At 30-day follow-up, the patient is doing well and tolerating a solid diet.

Discussion:

The incidence of gastrogastric fistula has decreased and, currently, the incidence of gastrogastric fistula ranges from 0% to 6% of RYGBs. ^{1 –4} Based on the patient's surgical history, this fistula was a technical complication that was caused by incomplete division of the stomach during the creation of the gastric pouch. To avoid this complication, it is crucial to observe the entire stomach and document that the pouch and gastric remnant are physically divided.

No competing financial interests exist.

Runtime of video: 7 mins 19 secs