ArticleObesity surgery2022
Laparoscopic Handsewn Gastrojejunostomy Revision of Gastrojejunal Anastomosis with Takedown of Gastro-gastric Fistula.
Article in Obesity surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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3 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.
- Diagnosis and treatment of chronic abdominal pain after bariatric surgery: a systematic review.Surgical endoscopy · 2026Pooled it
- Endoscopic Closure of Gastric Fistula After Bariatric Surgery Using the Over-the-Scope Clip (OTSC): A Case Report.Clinical medicine insights. Case reports · 2025Article
- Marginal Ulcers after Roux-en-Y Gastric Bypass: Etiology, Diagnosis, and Management.Journal of clinical medicine · 2023Review
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Authors and funding
2 authors at 1 institution in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundMarginal ulcer (MU) and gastro-gastric fistula (GGF) are well-described complications following Roux-en-Y gastric bypass (RYGB). The incidence of MU ranges from 0.6 to 25% and the incidence of GGF following divided RYGB has been reported as high as 6%. MU has been shown to be associated with GGF with a 53% incidence of MU in patients with GGF versus 4% in patients without GGF. Other risk factors for developing GGF previously identified in the literature include incomplete gastric transection, staple-line leak, and foreign body erosion. Management of GGF begins with aggressive medical therapy aimed at decreasing acid production, and surgical intervention is indicated for persistent symptoms such as weight gain or persistent ulcers. Endoscopic therapy is not recommended given risk of failure in setting of chronic inflammation.
methodsTo demonstrate the operative management of gastro-gastric fistula from chronic marginal ulcer. A 52-year-old female who had previous robotic RYGB in 2012 developed a chronic marginal ulcer and was diagnosed with a gastro-gastric fistula in 2017. She had a suspected perforation of her marginal ulcer in 2018, although no ulcer was found on laparoscopic exploration. She was taken to the OR for revision in 2018 for chronic marginal ulcer and strictures. Two gastro-gastric fistulas were found and resected, and a redo gastrojejunostomy was performed.
resultsWe used a handsewn RYGB technique in this patient, and other options include circular or linear techniques to create the gastrojejunal anastomosis [GJA]. We have found the rate of both stricture and marginal ulcer higher after circular stapled GJA technique. She did well post-operatively and did not have any further issues with marginal ulcers or strictures.
conclusionsA significant number of patients with GGF will fail maximal medical therapy and will require surgical treatment. Laparoscopic resection of GGF is the most well-described surgical technique, with or without revision of the gastrojejunostomy depending on presence of anastomotic stricture, marginal ulcer, or involvement with GG fistula. Surgical therapy has been shown to lead to good outcomes.
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