title: Surgical management of gastrogastric fistula.
abstract: BACKGROUND
  Gastrogastric fistula (GGF) is a rare complication after Roux-en-Y gastric bypass (RYGB) that can be challenging to treat.
  
  
  OBJECTIVE
  The aim of this study is to examine our surgical experience in the management of GGF after RYGB.
  
  
  METHODS
  Academic center, United States.
  
  
  METHODS
  We report a consecutive series of 36 patients who underwent surgery for GGF at our institution between 2005 and 2013.
  
  
  RESULTS
  The cohort had a mean age of 48.0±10.8 years, mean body mass index (BMI) of 34.6±11.3 kg/m(2), and an average number of 5.0±2.0 co-morbidities at the time of GGF revision. Of the 36 patients, 16 (44.4%) had previous open RYGB. Endoscopy confirmed GGF in 26 patients (72.2%), whereas upper gastrointestinal (GI) series indicated GGF in 21 of 30 cases (70.0%). The GGF surgery was on average 6.4±3.8 years after the primary procedure. All patients underwent surgical management either in the form of a redo gastrojejunal anastomosis with excision of fistula (77.7%) or a remnant gastrectomy with excision of fistula (22.2%). Mean operative time, blood loss, and length of stay were 248.4±103.3 minutes, 232.7±270.2 mL, and 8.5±8.6 days, respectively. One major intraoperative and 6 early postoperative complications occurred. After a mean follow-up of 38.4±30.0 months, the mean BMI was 35.5±6.2 kg/m(2) in patients with weight regain before GGF revision (P<.05) versus 25.0±6.1 kg/m(2) in patients without weight regain (P = .7).
  
  
  CONCLUSIONS
  GGF is a rare complication of RYGB. Surgical treatment should be tailored to the presenting symptoms and associated anatomic abnormality. Anastomotic revisions are associated with higher complication rates.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Fundació Clínic per la Recerca Biomèdica. Hospital Clínic of Barcelona, Universitat de Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Surgery, Kuwait University, Kuwait.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Jamal
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rogula
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: BRETHAS@ccf.org.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; Gastrogastric fistula; Gastrogastric fistula treatment