The Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.
Surg Endosc. 2009 Nov;23(11):2591-5. doi: 10.1007/s00464-009-0465-8. Epub 2009 May 22.
Gastrogastric fistula (GGF) is a rare complication after divided Roux-en-Y gastric bypass (RYGBP). The incidence can be as high as 49% in patients who undergo nondivided or partially divided RYGBP. We have previously reported a GGF rate of 1.5% after divided RYGBP. Remnant gastrectomy has been advocated by our group as a treatment option for this complication. We report our initial experience using the laparoscopic approach.
After IRB approval and following HIPAA guidelines, we conducted a retrospective review of prospectively collected database of 1,796 patients who underwent RYGB from 2001 and to 2008 at the Bariatric and Metabolic Institute. Data included mean time to laparoscopic remnant gastrectomy (LRG), mean length of hospital stay, follow-up period after laparoscopic remnant gastrectomy, rate of conversion, type of procedure performed, and early and late postoperative complications.
Twenty-one (1.1%) patients have been diagnosed with GGF; 11 more patients were admitted with GGF after undergoing initial RYGB at another institution. All patients (n = 32) were initially treated with sucralfate and proton pump inhibitors, and 22 of 32 patients eventually underwent LRG: 1 underwent fistulectomy, 1 underwent conversion of vertical banded gastroplasty to RYGB, and the remaining 8 patients have undergone only medical treatment. The mean time to LRG was 9 months from the time of diagnosis of GGF. Two of the 22 patients had conversion to an open approach: one because of a loss of poor visual surgical field resulting from excessive intraluminal air from intraoperative endoscopy and the other as a result of the inability to understand the anatomy laparoscopically. Three of the 22 patients (13%) underwent LRG and redo gastrojejunostomy because of a stenosed gastrojejunostomy. The mean hospital stay after LRG was 4.7 (range, 3-8) days. Early postoperative complications included intra-abdominal bleeding, pneumonia, wound infections, and fever of unknown origin. Late complications included intra-abdominal abscess, wound infections, fever, and food impactation. The follow-up period after LRG was an average of 4 (range, 1-11) months. During the follow-up period, there was no evidence of marginal ulceration, bleeding, abdominal pain, or recurrence of the GGF in any patient.
Laparoscopic remnant gastrectomy seems to be a safe and effective treatment option for patients with GGF after RYGBP.
胃胃吻合口瘘（Gastrogastric fistula，GGF）是 Roux-en-Y 胃旁路术（RYGBP）后一种罕见的并发症。非分割或部分分割 RYGBP 术后患者的发生率高达 49%。我们之前报道过分割 RYGBP 后 GGF 的发生率为 1.5%。我们的团队提倡残胃切除术作为这种并发症的治疗选择。我们报告了使用腹腔镜方法的初步经验。
在获得机构审查委员会批准并遵循 HIPAA 指南后，我们对 2001 年至 2008 年在减重与代谢研究所接受 RYGB 的 1796 例患者的前瞻性数据库进行了回顾性分析。数据包括腹腔镜残胃切除术（LRG）的平均时间、平均住院时间、LRG 后随访时间、转化率、所行手术类型以及早期和晚期术后并发症。
21 例（1.1%）患者被诊断为 GGF；另有 11 例患者在另一机构接受初始 RYGB 后因 GGF 入院。所有患者（n=32）最初均接受硫糖铝和质子泵抑制剂治疗，32 例患者中有 22 例最终接受 LRG：1 例行瘘管切除术，1 例行垂直带胃成形术改行 RYGB，其余 8 例仅行药物治疗。从 GGF 诊断到行 LRG 的平均时间为 9 个月。22 例患者中有 2 例转为开腹手术：1 例因术中内镜导致术中腔内空气过多导致手术视野不佳，另 1 例因无法腹腔镜下理解解剖结构而转为开腹手术。22 例患者中有 3 例（13%）因胃空肠吻合口狭窄而行 LRG 和再行胃空肠吻合术。LRG 后平均住院时间为 4.7（3-8）天。早期术后并发症包括腹腔内出血、肺炎、伤口感染和不明原因发热。晚期并发症包括腹腔脓肿、伤口感染、发热和食物嵌塞。LRG 后的随访时间平均为 4（1-11）个月。在随访期间，没有患者出现边缘性溃疡、出血、腹痛或 GGF 复发的证据。
腹腔镜残胃切除术似乎是 RYGBP 后 GGF 患者的一种安全有效的治疗选择。
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