Endoscopic treatment of Roux-en-Y gastric bypass-related gastrocutaneous fistulas using a novel biomaterial.
BACKGROUND
Roux-en-Y gastric bypass (RYGB) is amongst the commonest surgical intervention for weight loss in obese patients. Gastrocutaneous fistula, which usually occurs along the vertical staple line of the pouch, is amongst its most alarming complications. Medical management comprised of wound drainage, nutritional support, acid suppression, and antibiotics may be ineffective in as many as a third of patients with this complication. We present outcomes after endoscopic application of SurgiSIS, which is a novel biomaterial for the treatment of this complication.


METHODS
A case series of 25 patients.


METHODS
Twenty-five patients who had failed conservative medical management of gastrocutaneous fistula after RYGB underwent endoscopic application of SurgiSIS--an acellular fibrogenic matrix biomaterial to help fistula healing.


METHODS
Fistula closure as assessed by upper gastrointestinal imaging and endoscopic examination.


RESULTS
In patients who had failed medical management lasting 4-25 (median, 7) weeks, closure of the fistulous tract was successful after one application in six patients (30%), two applications in 11 patients (55%), and three applications in three patients (15%). There were no procedure-related complications.


CONCLUSIONS
Endoscopic application of SurgiSIS-an acellular fibrogenic matrix--is safe and effective for the treatment of gastrocutaneous fistula after RYGB.
Maluf-Filho
Fauze
F
Gastrointestinal Endoscopy Unit, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. fauze.maluf@terra.com.br
Hondo
Fabio
F
Halwan
Bhawna
B
de Lima
Marcelo Simas
MS
Giordano-Nappi
José Humberto
JH
Sakai
Paulo
P
D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D004724:Endoscopy / Q000379:methods*; D005109:Extracellular Matrix; D005260:Female; D015390:Gastric Bypass; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D013552:Swine; D054457:Tissue Scaffolds
D000900:Anti-Bacterial Agents; D001672:Biocompatible Materials; D054328:Proton Pump Inhibitors