Gastro-gastric Fistula between Pouch and Fundus following Gastric Banding and Bypass

Abstract

A complication observed with revisional surgery involving a fistula between the former pouch after gastric banding and the fundus is described. A 59-year-old man with BMI 41 kg/m(2) presented for Roux-en-Y gastric bypass (RYGBP). He had previously undergone an open gastric banding operation, with the band removed for obstruction 1 year later. He presented to our hospital with a third incisional hernia which was so large that he suffered from abdominal angina following meals. A RYGBP and a hernia repair with mesh were performed. The postoperative contrast x-ray study disclosed a fistula between the pouch and fundus. A procedure to close the fistula became necessary. The reason for the fistula may have been an erosion at the former connection between the pouch and the fundus after gastric banding, although a preoperative gastroscopy had not revealed this fistula.

Endoscopic Management of Gastrogastric Fistulae Does Not Increase Complications at Bariatric Revision Surgery

“…A noted complication in up to 46% of cases when the gastric pouch is created in continuity with the remnant stomach or only partially transected, recent data from the laparoscopic era report this complication in less than 6% of cases. [15][16][17][18][19][20][21][22][23] Patients with GGF may present clinically with suboptimal weight loss, acid reflux, abdominal pain, and/or nausea. [24][25][26] While some cases can be managed conservatively, most fistulae will require endoscopic or surgical management for complete closure.…”