title: Gastrogastric fistula: a possible complication of Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Gastrogastric fistula is a communication between the proximal gastric pouch and the distal gastric remnant, rarely described in the realm of bariatric procedures. The aim of this study was to review the existing literature about this topic and to demonstrate its laparoscopic treatment.
  
  
  METHODS
  An extensive literature review found several articles reporting this complication. However, no citation was found describing the steps of the laparoscopic management of this situation.
  
  
  RESULTS
  Gastrogastric fistula occurs in up to 6% of Roux-en-Y gastric bypasses. Two theories exist for fistula formation: (1) it is a technical complication derived from the incomplete division of the stomach during the creation of the pouch, and (2) it occurs after a staple-line failure, developing a leak with an abscess, which then drains into the distal stomach forming the fistula. Early symptoms include fever, tachycardia, and abdominal pain. Failure in weight loss is a late clinical sign observed in these patients. Diagnosis is based on radiologic study, upper endoscopy and computed tomography. When identified in the acute postoperative course, laparoscopic treatment is easy. Chronic fistulas are difficult to manage, and the laparoscopic approach is an alternative to open surgery.
  
  
  CONCLUSIONS
  Gastrogastric fistula is a possible complication of Roux-en-Y gastric bypass and its laparoscopic treatment is feasible.
authors.affiliation: Department of General Surgery, Irmandade Santa Casa de Misericórdia de Curitiba, Paraná, Brazil.
authors.forename: Alcides José Branco
authors.initials: AJ
authors.lastname: Filho
authors.forename: William
authors.initials: W
authors.lastname: Kondo
authors.forename: Luis Sérgio
authors.initials: LS
authors.lastname: Nassif
authors.forename: Mariana Jorge
authors.initials: MJ
authors.lastname: Garcia
authors.forename: Rafael de Almeida
authors.initials: Rde A
authors.lastname: Tirapelle
authors.forename: Carlos Marcelo
authors.initials: CM
authors.lastname: Dotti
mesh_terms: D000713:Anastomosis, Roux-en-Y; D015390:Gastric Bypass; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D011183:Postoperative Complications