Gastrogastric fistulas. A complication of divided gastric bypass surgery.
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Date
1995-04
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Authors
Cucchi, Sharon G. D.
Pories, Walter J.
MacDonald, Kenneth G. Jr.
Morgan, Elizabeth J.
Journal Title
Journal ISSN
Volume Title
Publisher
East Carolina University
Abstract
Objective
This report warns that gastrogastric fistulas may follow the division of the stomach in bariatric surgery.
Summary Background Data
Although surgery is the most effective therapy for morbid obesity, the procedures are still undergoing evolution. One of the key elements in bariatric surgery is the partition of the stomach to develop a much smaller reservoir. The partition has been done with single layers of staples with almost universal failure and with double layers of staples with a failure rate of 11.8% when observed for a 12-year follow-up.
Methods
This report details the experience with a series of 100 consecutive patients in whom the partition was created by dividing the stomach.
Results
The course of six patients was complicated by gastrogastric fistulas. One of the patients had the gastric bypass as the initial bariatric operation; in the other five, the gastric bypasses were carried out to revise failed staple lines. Although one of the patients required drainage for a subphrenic abscess, two had only self-limited signs of infection. In the remaining three patients, there was no evidence of any complication.
Conclusion
Gastrogastric fistulas followed division of the stomach in 6% of our gastric bypass operations. Methods for avoiding this complication include oversewing staple lines, using strong bites of
tissue during the anastomosis, avoiding obstruction of the Roux-en-Y jejunal segment, and testing
of the integrity of the anastomosis with methylene blue dyes. The ideal method for partition of the stomach remains to be developed. Originally published Annals of Surgery, Vol. 221, No. 4, Apr 1995
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Citation
Annals of Surgery; 221:4 p. 387-391
DOI
10.1097/00000658-199504000-00009