Remnant Gastrectomy and Hiatal Hernia Repair in a Patient Status Post Gastric Bypass with Recurrent Marginal Ulceration and GERD Due to Gastro-Gastric Fistula

Emanuele Lo Menzo, MD, PhD

Cleveland Clinic Florida

Introduction: Marginal ulceration can lead to gastro-gastric fistulas and may necessitate revisional procedures.

Materials and Methods: This a 42-years-old woman underwent with a history of gastric bypass approximately 7 years prior, presented with persistant back pain and recurrent anastomotic ulcer. Both the UGI and the EGD showed gastro-gastric fistula. The patient underwent a laparoscopic revision. The gastric remnant is identified and divided distally with the linear stapler. The whole gastric remnant and the fistulous tract are excised en-bloc. The staple lines were oversewn. Then a hiatal was repaired with a knotless suture (Quill™).

Result: The patient tolerates the procedure well. Recovery was uneventful, normal UGI on POD 1 without leak or obstruction.

Conclusion: Gastro-gastric fistulas can be a complication of marginal ulceration after RYGB. Reoperation and laparoscopic revision of the gastric pouch as well as resection of the gastric remnant is necessary in most cases.

Key Words: Morbid Obesity, Gastric Bypass Revision, Anastomotic Stricture, Laparoscopy, Complication

Session: Video Channel Day 1

Program Number: V050

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