Roux limb to gastric remnant fistula: An unreported complication of roux-en-y gastric bypass surgery

Farah Karipineni, MD, MPH, Ian Soriano, MD

Albert Einstein Medical Center, Philadelphia, PA

Background and objectives: Gastrogastric fistulas (GGFs) are seen in 1.5% to 12.5% of patients after Roux-en-Y gastric bypass (RYGB) bariatric surgery, often leading to abdominal pain, dry heaving, and failure to lose adequate weight. Roux limb to gastric remnant fistula is a rare complication that has not previously been discussed in the literature. The aim of this study was to report on our management of proximal roux limb to gastric remnant fistulas in two patients with different presentations and management.

Setting: Tertiary referral teaching hospital, Einstein at Elkins Park, Philadelphia, Pennsylvania.

Methods: In the first patient, laparoscopic management was employed to take down a proximal roux limb to gastric remnant fistula one year after an endoscopic divided antecolic, antegastric roux-en-y gastric bypass (RYGB). The procedure performed was en bloc resection of the gastrojejunal anastamosis, the proximal roux limb and the proximal gastric remnant including the fistula with gastric tube placement in the remaining gastric remnant and re-do gastrojejunostomy. In the second patient, no intervention was undertaken as the patient’s only symptom was weight regain and she elected for nonoperative management.

Results: In the first case, the procedure was performed laparoscopically without complications and resulted in resolution of the patient’s symptoms and continued weight loss. In the second case, the patient developed no further symptoms from nonoperative management and weight loss has resumed with behavioral changes.

Discussion: Roux limb to gastric remnant fistulas are a rare complication of RYGB procedures. Laparoscopic management can be performed safely and successfully in select populations.

Session: Poster Presentation

Program Number: P589

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