Document Detail

Endolumenal revision obesity surgery results in weight loss and closure of gastric-gastric fistula.
MedLine Citation:
PMID:  21474389     Owner:  NLM     Status:  Publisher    
BACKGROUND: Approximately 20-50% of patients regain weight 3-5 years after Roux-en-Y gastric bypass (RYGB) surgery. Gastric-gastric fistulas and dilation of the gastrojejunostomy and gastric pouch have been reported in these patients. Traditional revision surgery after RYGB has greater morbidity and mortality compared with the index bariatric procedure. We studied our initial results with revision of obesity surgery using an endoscopic platform in a community hospital setting. METHODS: A retrospective review was performed of patients who had undergone this endoscopic revisional procedure secondary to significant weight regain with or without gastric-gastric fistula. All patients underwent revision of the gastrojejunostomy and/or closure of the gastric-gastric fistula using this minimally invasive approach. RESULTS: A total of 37 consecutive patients (36 women) with a mean age of 45 years and mean weight regain of 15.1 ± 10.0 kg were included in the present study. The mean interval between RYGB and revision was 5.2 years (range 1-11). The mean preoperative and postoperative stomal size was 21.5 and 10 mm, respectively. Anchors were successfully placed in all patients. The mean follow-up period was 4.69 months (range 2-10). The mean percentage of excess body weight loss was 23.5% ± 66.4%. No immediate complications developed. Two patients underwent endoscopic dilation of the stoma because of persistent meal intolerance. Three gastric-gastric fistulas were successfully closed. CONCLUSION: Revision of gastrojejunostomy after RYGB can be safely undertaken using this endoscopic platform. The short-term follow-up results showed clinically significant weight loss. Long-term follow-up is needed. Closure of gastric-gastric fistulas can also be achieved using this procedure.
Shankar R Raman; Spencer Holover; Shawn Garber
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-22
Journal Detail:
Title:  Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery     Volume:  -     ISSN:  1878-7533     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-4-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101233161     Medline TA:  Surg Obes Relat Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York.
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