Gastrogastric fistula: a possible complication of Roux-en-Y gastric bypass.
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.
Filho
Alcides José Branco
AJ
Department of General Surgery, Irmandade Santa Casa de Misericórdia de Curitiba, Paraná, Brazil.
Kondo
William
W
Nassif
Luis Sérgio
LS
Garcia
Mariana Jorge
MJ
Tirapelle
Rafael de Almeida
Rde A
Dotti
Carlos Marcelo
CM
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