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Laparoscopic Gastric Bypass Revision

Janey Sue Pratt, MD
Massachusetts General Hospital

Abstract

Gastro-gastric fistula is a rare complication following a roux-en-y gastric bypass procedure wherein there is a communication between the proximal gastric pouch and the distal gastric remnant. Patients typically present with nausea and vomiting, abdominal pain, intractable marginal ulcer, bleeding, reflux, poor weight loss, and weight regain. Etiologies include postoperative roux-en-y gastric bypass leaks, incomplete gastric division, marginal ulcers, distal obstruction, and erosion of foreign body. Diagnosis is made through upper gastro-intestinal contrast radiography or CT scan and endoscopy. Barium contrast radiography is particularly useful and is the preferred initial study method for the detection of staple-line dehiscence, which may be small and overlooked during endoscopy. Once identified, a gastro-gastric fistula may be treated surgically with remnant gastrectomy or gastrojejunostomy revision. Here, we present a case of a female patient status post roux-en-y gastric bypass surgery who presented with abdominal pain. Upon endoscopy, she was noted to have an inflamed gastric pouch and a gasto-gastric fistula. A laparoscopic gastric bypass revision was done to divide the gastro-gastric fistula and to separate the gastric pouch from the gastric remnant in order to alleviate the inflamed gastric pouch and prevent further ulcer formation.

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