title: A new approach for treatment of gastro-gastric fistula after gastric bypass.
abstract: We report a novel technique for gastro-gastric fistula (GGF) repair. A 44-year-old woman was found to have a fistula between her gastric pouch and bypassed stomach 18 years after Roux-en-Y gastric bypass (RYGBP) for morbid obesity. She underwent an attempted open surgical repair, which was complicated by postoperative abdominal sepsis. An upper gastrointestinal series, abdominal CT scan and upper endoscopy confirmed the diagnosis of failed surgery with recurrent GGF. Under endoscopic and fluoroscopic guidance, two ports were inserted percutaneously into the stomach. The fistula was closed with a percutaneous, transgastric, totally extraperitoneal approach. She remains well 7 months after this intervention. This procedure appears to be a safe and effective minimally invasive approach for closure of GGF after RYGBP. This is the first description of an intragastric, percutaneous closure of a GGF after RYGBP in the medical literature. Further experience with this technique is needed to define the selection criteria, limitations, advantages, and disadvantages.
authors.affiliation: Departments of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Torres-Villalobos
authors.forename: Daniel
authors.initials: D
authors.lastname: Leslie
authors.forename: Todd
authors.initials: T
authors.lastname: Kellogg
authors.forename: Rafael
authors.initials: R
authors.lastname: Andrade
authors.forename: Michael
authors.initials: M
authors.lastname: Maddaus
authors.forename: David
authors.initials: D
authors.lastname: Hunter
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology* / Q000601:surgery*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery; D013536:Suture Techniques