title: Endoscopic management of gastrogastric fistulae does not increase complications at bariatric revision surgery.
abstract: BACKGROUND
  Gastrogastric fistula (GGF) is a challenging complication of primary obesity surgery that often leads to revision surgery. The impact of prior endoscopic intervention on subsequent surgical revisional outcomes remains unknown. We present the largest series of Roux-en-Y gastric bypass GGF with subsequent surgical revision of fistulae to date.
  
  
  METHODS
  A database of bariatric surgical revisions performed at a single institution was collected. The cohort was divided between patients with and without attempted endoscopic fistula closure prior to surgical revision. Thirty-day morbidity and mortality was the primary outcome.
  
  
  RESULTS
  Thirty-five cases of revision were performed for GGF. Of the 35 cases, 22 patients had attempted endoscopic closure prior to surgical revision while 13 patients went directly to surgical revision. In the endoscopy group, two minor complications and seven major complications occurred (total 9 of 22; 40.9%). In the surgery only group, three minor complications and three major complications occurred (total 6 of 13; 46.1%). No deaths occurred.
  
  
  CONCLUSIONS
  Prior attempts at endoscopic fistula closure do not lead to increased surgical complications at the time of surgical revision.
authors.affiliation: Brigham and Women's Hospital, Boston, MA 02115, USA. mflicker@partners.org
authors.forename: Michael S
authors.initials: MS
authors.lastname: Flicker
authors.forename: David B
authors.initials: DB
authors.lastname: Lautz
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Thompson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004724:Endoscopy; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects; D016896:Treatment Outcome