Roberts Kurt E, Duffy Andrew J, Bell Robert L
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
Surg Innov. 2007 Mar;14(1):18-23. doi: 10.1177/1553350606298966.
Gastrogastric fistulas are an uncommon complication following laparoscopic Roux-Y gastric bypass surgery (LRYGB) and may be caused by staple-line dehiscence or leak. Described here is a novel technique to treat these fistulae via a laparoscopic transgastric approach and closure of the fistulous tract with an Endo Stitch device. The 33-year-old patient, post LRYGB in 2002, with documented gastrogastric fistula, had failed non-operative management. A transoral endoscope was passed into the cephalad portion of the gastrogastric fistula; a glidewire was passed from the gastric pouch into the gastric remnant. Laparoscopically, 2 gastrotomies were made and a "pneumogastrium" created with carbon dioxide. Under direct, transgastric visualization, the distal portion of the gastrogastric fistula was closed using an Endo Stitch device. This technique is safe and reproducible when performed by an experienced laparoscopic surgeon and could be modified for other scenarios requiring alternate access to the stomach.
胃胃瘘是腹腔镜Roux-Y胃旁路手术（LRYGB）后一种罕见的并发症，可能由吻合钉线裂开或渗漏引起。本文介绍了一种通过腹腔镜经胃途径治疗这些瘘管的新技术，即使用Endo Stitch装置封闭瘘管。该33岁患者于2002年接受LRYGB手术后，经证实存在胃胃瘘，非手术治疗失败。将经口内镜插入胃胃瘘的头侧部分；一根导丝从胃囊插入胃残端。在腹腔镜下，做了两个胃切开术，并注入二氧化碳形成“胃内气腹”。在经胃直接可视化下，使用Endo Stitch装置封闭胃胃瘘的远端部分。当由经验丰富的腹腔镜外科医生实施时，该技术是安全且可重复的，并且可以针对其他需要通过不同途径进入胃的情况进行改良。
