Preliminary report: search for a transgastric approach for managing gastrogastric fistulas.
BACKGROUND
Revision surgery to eliminate a gastrogastric fistula (GGF) is often associated with high morbidity.


METHODS
This report describes a percutaneous transgastric approach for revision surgery in three patients with GGF using a transgastric, totally extraperitoneal approach.


RESULTS
The access was performed successfully in all the patients. There were no intraoperative complications, and the patients had an uneventful recovery. One patient had a recurrence 8 months after the procedure but had achieved satisfactory weight loss during the period. We were able to perform a second percutaneous transgastric repair. The second patient showed an asymptomatic recurrence of the fistula, which was later completely repaired. The third patient has had moderate weight loss.


CONCLUSIONS
Although current results are not optimal, we believe that this approach could represent an alternative for patients with a hostile abdomen or in whom co-morbidities comprise a prohibitive factor. Further experience, technical improvements, and longer follow-up are needed to evaluate and optimize this approach and evaluate its potential use in other surgical areas.
Department of Surgery, University of Minnesota, 420 Delaware Street, MMC 290, Minneapolis, MN 55455, USA. torresvgm@yahoo.com.mx
Gonzalo
G
Torres-Villalobos
Daniel B
DB
Leslie
David
D
Hunter
Henry
H
Buchwald
Luis A
LA
Martin-del-Campo
Sayeed
S
Ikramuddin
D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D005747:Gastric Fistula / Q000601:surgery*; D006801:Humans; D013270:Stomach