Gastrogastric Fistulas A Complication of Divided Gastric Bypass Surgery

Abstract

ObjectiveThis report warns that gastrogastric fistulas may follow the division of the stomach in bariatric surgery. Summary Background DataAlthough surgery is the most effective therapy for morbid obesity, the procedures are still undergoing evolution. One of the key elements in bariatric surgery is the partition of the stomach to develop a much smaller reservoir. The partition has been done with single layers of staples with almost universal failure and with double layers of staples with a failure rate of 11.8% when observed for a 12-year follow-up. MethodsThis report details the experience with a series of 100 consecutive patients in whom the partition was created by dividing the stomach. ResultsThe course of six patients was complicated by gastrogastric fistulas. One of the patients had the gastric bypass as the initial bariatric operation; in the other five, the gastric bypasses were carried out to revise failed staple lines. Although one of the patients required drainage for a subphrenic abscess, two had only self-limited signs of infection. In the remaining three patients, there was no evidence of any complication. ConclusionGastrogastric fistulas followed division of the stomach in 6% of our gastric bypass operations.Methods for avoiding this complication include oversewing staple lines, using strong bites of tissue during the anastomosis, avoiding obstruction of the Roux-en-Y jejunal segment, and testing of the integrity of the anastomosis with methylene blue dyes. The ideal method for partition of the stomach remains to be developed.

Surgical Management of Gastro–Gastric Fistula After Divided Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity

“…GGF continue to occur with a reported incidence of up to 6%. 10,12,13 We have previously reported a 1.2% incidence of GGF in our series of patients after divided LRYGB. 14 The optimal management of GGF remains controversial, and reports of surgical treatment of this complication are infrequent.…”

Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients

“…Staple line dehiscence is seen primarily when the pouch is created by an undivided staple line through the proximal stomach [4,5,8]. Clearly, once a connection between the gastric remnant and the pouch is established, the jejunal mucosa is exposed to a greater volume of low-pH fluid.…”

Gastric Bypass: Current Results and Different Techniques

“…In 1995, Cucchi et al [50] observed an incidence rate of 6%. The high incidence might be a result of the stapling devices used in the former days, which did not divide the gastric tissue.…”