Gastrogastric fistula following Roux-en-Y bypass is attributed to both surgical technique and experience.
BACKGROUND
The stomach can either be divided or undivided in performing Roux-en-Y gastric bypass (RGB) for morbid obesity. We evaluated whether surgical technique is the sole contributing factor to the formation of gastrogastric fistula (GGF).


METHODS
A retrospective analysis of 1,036 consecutive patients was evaluated. RGB was performed as open undivided, open divided, and laparoscopic (divided). Incidence of GGF was identified for each technique and its relationship to surgical experience was assessed.


RESULTS
Overall incidence of GGF was 1.3%. All fistulae occurred in patients who received undivided open RGB. There was a significant difference between the undivided open group and the divided open+laparoscopic groups (2.1% vs 0%, P<.01). Incidence of GGF decreased over time with increasing open undivided RGB volume.


CONCLUSIONS
GGF was only identified in undivided RGB. The occurrence decreased with increasing surgical experience. Together, overall surgical technique in addition to gastric division must play a role in fistula formation.
Department of General Surgery, Case Western Reserve University School of Medicine, University Suburban Health Center, 1611 S. Green Rd., Suite 200, South Euclid, OH 44121, USA.
David C
DC
Yao
Thomas A
TA
Stellato
Margaret M
MM
Schuster
Kristen N
KN
Graf
Peter T
PT
Hallowell
D000328:Adult; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000592:standards*; D005747:Gastric Fistula / Q000209:etiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies