GASTROGASTRIC FISTULAS - A COMPLICATION OF DIVIDED GASTRIC BYPASS-SURGERY

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, th e procedures are still undergoing evolution. One of the key elements i n bariatric surgery is the partition of the stomach to develop a much smaller reservoir. The partition has been done with single layers of s taples 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. M ethods This report details the experience with a series of 100 consecu tive patients in whom the partition was created by dividing the stomac h. Results The course of six patients was complicated by gastrogastric fistulas. One of the patients had the gastric bypass as the initial b ariatric operation, in the other five, the gastric bypasses were carri ed out to revise failed staple lines. Although one of the patients req uired drainage for a subphrenic abscess, two had only self-limited sig ns of infection. In the remaining three patients, there was no evidenc e of any complication. Conclusion Gastrogastric fistulas followed divi sion of the stomach in 6% of our gastric bypass operations. Methods fo r avoiding this complication include oversewing staple lines, using st rong bites of tissue during the anastomosis, avoiding obstruction of t he Roux-en-Y jejunal segment, and testing of the integrity of the anas tomosis with methylene blue dyes. The ideal method for partition of th e stomach remains to be developed.