Laparoscopic Remnant Gastrectomy: A Novel Approach to Gastrogastric Fistula after Roux-en-Y Gastric Bypass for Morbid Obesity

Cho, Minyoung; Kaidar-Person, Orit; Szomstein, Samuel; Rosenthal, Raul J.

doi:10.1016/j.jamcollsurg.2007.01.054

« Previous Next »Journal of the American College of Surgeons
Volume 204, Issue 4 , Pages 617-624, April 2007

Laparoscopic Remnant Gastrectomy: A Novel Approach to Gastrogastric Fistula after Roux-en-Y Gastric Bypass for Morbid Obesity

Minyoung Cho, MD, PhD
- Department of Surgery, The Bariatric Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL
- College of Medicine, Korea University, Seoul, Korea.
Orit Kaidar-Person, MD
- Department of Surgery, The Bariatric Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL
Samuel Szomstein, MD, FACS
- Department of Surgery, The Bariatric Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL
Raul J. Rosenthal, MD, FACS
- Department of Surgery, The Bariatric Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, FL
- Correspondence address: Raul J Rosenthal, MD, FACS, Bariatric Institute and Section of Minimal Invasive Surgery, Department of General and Vascular Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331.

Received 6 October 2006; received in revised form 13 December 2006; accepted 22 January 2007.

Background

Gastrogastric fistula (GGF) is a relatively rare and devastating complication after divided Roux-en-Y gastric bypass (RYGB) for morbid obesity. The aim of this study was to review laparoscopic remnant gastrectomy (LRG) as a novel treatment option for this complication.

Study Design

After IRB approval, we retrospectively reviewed data from all patients who underwent bariatric surgery at Cleveland Clinic Florida and from all patients who were diagnosed with GGF as a complication of RYGB, between January 2000 and March 2005. Data collected included demographics, body weight, symptoms, initial diagnostic method, indications for LRG, and postoperative complications.

Results

Of 1,400 patients who had undergone RYGB in our institution during the study period, 21 patients (1.5%) were diagnosed with GGF; 4 more patients who were admitted with GGF after RYGB underwent the initial operation at another institution. Of these, 15 patients underwent LRG. Indications for surgical treatment were intractable epigastric pain (10 of 15), upper gastrointestinal bleeding (2 of 15), intolerance of soft diet (2 of 15), and weight regain (1 of 15). Mean hospital length of stay after the procedure was 4.7 days. There was no mortality, and there was no recurrence of GGF during the followup period.