Surgical endoscopy · 2025
Impact of post-RYGB gastrogastric fistula repair on metabolic and reflux outcomes.
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Martin Thomas J, Ehsan Kassra, Wasden Katherine, Nimeri Abdelrahman, Sheu Eric G, Tavakkoli Ali
Аннотация
BACKGROUND: Gastrogastric fistula (GGF) is a rare complication of Roux-en-Y gastric bypass (RYGB) associated with recurrent weight gain, worsening reflux, and Type II diabetes (T2DM) recurrence. Though surgical repair improves weight loss, the metabolic and reflux-related benefits remain ill-defined.
METHODS: Case series of RYGB patients with GGF who underwent laparoscopic repair via GGF takedown with partial gastrectomy without concurrent gastrojejunal anastomotic revision or bypass distalization, stratified by GLP-1 exposure. Anthropometric and metabolic parameters were abstracted pre- and post-RYGB, on GGF diagnosis, and following repair. Cumulative fistula size was estimated from preoperative endoscopy. Outcomes included total weight loss (TWL%), HbA1c, changes in antidiabetic therapy, reflux outcomes, and complications.
RESULTS: Thirty-one patients, 28 (90.3%) female with mean (SD) age of 52.7 (8.6), underwent GGF repair between 2014 and 2024. Index RYGB was performed 16.8 (5.8) years earlier with 27 (87.1%) in open fashion. Median [IQR] cumulative fistula size was 15 [11.3, 20] mm. Fourteen (45.2%) patients received pre- and/or postoperative GLP-1 agonists and 14 (45.2%) underwent previous unsuccessful attempts at endoscopic closure. On diagnosis, 24 (77.4%) patients had symptomatic reflux, 6 (19.4%) prediabetes, and 4 (12.9%) T2DM. Concurrent hiatal hernia repair was performed in 5 (15.6%) cases. One year following repair, mean TWL% was - 14.2% (12.3) relative to repair, 83.3% had clinical resolution of reflux, and those with prediabetes or diabetes exhibited mean [95%CI] HbA1c reduction of - 0.64 [- 1.0, - 0.28].
CONCLUSION: Laparoscopic GGF repair following RYGB is associated with significant weight loss, resolution of reflux symptoms, and metabolic improvements, even following trials of medical or endoscopic therapy. Our study highlights the potential metabolic impact of GGF and supports the evaluation and repair of GGF in appropriate candidates with recurrent weight gain, reflux, or diabetes after RYGB.
METHODS: Case series of RYGB patients with GGF who underwent laparoscopic repair via GGF takedown with partial gastrectomy without concurrent gastrojejunal anastomotic revision or bypass distalization, stratified by GLP-1 exposure. Anthropometric and metabolic parameters were abstracted pre- and post-RYGB, on GGF diagnosis, and following repair. Cumulative fistula size was estimated from preoperative endoscopy. Outcomes included total weight loss (TWL%), HbA1c, changes in antidiabetic therapy, reflux outcomes, and complications.
RESULTS: Thirty-one patients, 28 (90.3%) female with mean (SD) age of 52.7 (8.6), underwent GGF repair between 2014 and 2024. Index RYGB was performed 16.8 (5.8) years earlier with 27 (87.1%) in open fashion. Median [IQR] cumulative fistula size was 15 [11.3, 20] mm. Fourteen (45.2%) patients received pre- and/or postoperative GLP-1 agonists and 14 (45.2%) underwent previous unsuccessful attempts at endoscopic closure. On diagnosis, 24 (77.4%) patients had symptomatic reflux, 6 (19.4%) prediabetes, and 4 (12.9%) T2DM. Concurrent hiatal hernia repair was performed in 5 (15.6%) cases. One year following repair, mean TWL% was - 14.2% (12.3) relative to repair, 83.3% had clinical resolution of reflux, and those with prediabetes or diabetes exhibited mean [95%CI] HbA1c reduction of - 0.64 [- 1.0, - 0.28].
CONCLUSION: Laparoscopic GGF repair following RYGB is associated with significant weight loss, resolution of reflux symptoms, and metabolic improvements, even following trials of medical or endoscopic therapy. Our study highlights the potential metabolic impact of GGF and supports the evaluation and repair of GGF in appropriate candidates with recurrent weight gain, reflux, or diabetes after RYGB.