Bariatric revisional surgery for gastrogastric fistula following Roux-en-Y gastric bypass positively impacts weight loss

Published:December 10, 2022DOI:


      • Gastrogastric fistula (GGF) repair induces long-term weight loss after weight recurrence.
      • Surgical repair can be safely performed, however with higher complication rates.
      • GGFs are more common after open undivided Roux-en-Y gastric bypass (RYGB).



      Gastrogastric fistula (GGF) is a rare complication from Roux-en-Y gastric bypass (RYGB). It is a known risk factor associated with weight recidivism and an indication for Bariatric Revisional Surgery (BRS).


      The primary outcome of this study is to evaluate perioperative outcomes and the long-term total body weight loss (TBWL) outcomes following revision.


      Single Academic Institution, Center of Bariatric Excellence.


      We selected patients who had primary bariatric surgery and BRS from 2003 to 2020, followed by BRS for GGF. Patients’ demographics, perioperative outcomes, and TBWL were analyzed.


      One hundred five patients underwent BRS for GGF. Mean body mass index (BMI) at index operation and revision was 51.6 ± 10.1, and 42.4 ± 11.2 respectively. Ninety percent of patients had open primary RYGB, and 69% had open revisional surgery. The median length of stay after BRS was 3 days. The 30-day reintervention rate was 19%. The 30-day readmission rate was 34%. Of the 77 patients included for weight loss analysis, the mean %TBWL after primary RYGB was 34% ± 14. The total mean %TBWL at the time of revision was 18.8%, translating into a weight regain of 13.6% ± 9.5. The total mean %TBWL after revision was 37.6% ± 11.4, translating into TBWL of 18.8% ± 9.4 after revision when compared to TBWL at revision time.


      Our results demonstrate that revision for GGF can be safely performed, however is associated with higher morbidity than primary bariatric surgery. Revision for GGF results in significant long-term weight loss.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery for Obesity and Related Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shimizu Y.
        Obesity and overweight. World Health Organization.
        • Prevention. CfDCa
        Overweight & Obesity: Adult Obesity Facts.
        • Boido A.
        • Ceriani V.
        • Cetta F.
        • Lombardi F.
        • Pontiroli A.E.
        Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery.
        Nutr Metab Cardiovasc Dis. 2015; 25: 437-443
        • Colquitt J.L.
        • Picot J.
        • Loveman E.
        • Clegg A.J.
        Surgery for obesity.
        Cochrane Database Syst Rev. 2009; : CD003641
        • Glenny A.M.
        • O'Meara S.
        • Melville A.
        • Sheldon T.A.
        • Wilson C.
        The treatment and prevention of obesity: a systematic review of the literature.
        Int J Obes Relat Metab Disord. 1997; 21: 715-737
        • Colquitt J.L.
        • Pickett K.
        • Loveman E.
        • Frampton G.K.
        Surgery for weight loss in adults.
        Cochrane Database Syst Rev. 2014; : CD003641
        • Christou N.V.
        • Look D.
        • Maclean L.D.
        Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years.
        Ann Surg. 2006; 244: 734-740
        • Cucchi S.G.
        • Pories W.J.
        • MacDonald K.G.
        • Morgan E.J.
        Gastrogastric fistulas. A complication of divided gastric bypass surgery.
        Ann Surg. 1995; 221: 387-391
        • Meister K.M.
        • Schauer P.R.
        • Brethauer S.A.
        • Aminian A.
        Effect of gastrogastric fistula closure in type 2 diabetes.
        Obes Surg. 2018; 28: 1086-1090
        • Gumbs A.A.
        • Duffy A.J.
        • Bell R.L.
        Management of gastrogastric fistula after laparoscopic Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2006; 2: 117-121
        • Carrodeguas L.
        • Szomstein S.
        • Soto F.
        • Whipple O.
        • Simpfendorfer C.
        • Gonzalvo J.P.
        • et al.
        Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature.
        Surg Obes Relat Dis. 2005; 1: 467-474
        • Tucker O.N.
        • Szomstein S.
        • Rosenthal R.J.
        Surgical management of gastro-gastric fistula after divided laparoscopic Roux-en-Y gastric bypass for morbid obesity.
        J Gastrointest Surg. 2007; 11: 1673-1679
        • Chahine E.
        • Kassir R.
        • Dirani M.
        • Joumaa S.
        • Debs T.
        • Chouillard E.
        Surgical management of gastrogastric fistula after roux-en-Y gastric bypass: 10-year experience.
        Obes Surg. 2018; 28: 939-944
        • Nguyen D.
        • Dip F.
        • Huaco J.A.
        • Moon R.
        • Ahmad H.
        • LoMenzo E.
        • et al.
        Outcomes of revisional treatment modalities in non-complicated Roux-en-Y gastric bypass patients with weight regain.
        Obes Surg. 2015; 25: 928-934
        • Corcelles R.
        • Jamal M.H.
        • Daigle C.R.
        • Rogula T.
        • Brethauer S.A.
        • Schauer P.R.
        Surgical management of gastrogastric fistula.
        Surg Obes Relat Dis. 2015; 11: 1227-1232
        • Ribeiro-Parenti L.
        • De Courville G.
        • Daikha A.
        • Arapis K.
        • Chosidow D.
        • Marmuse J.P.
        Classification, surgical management and outcomes of patients with gastrogastric fistula after Roux-En-Y gastric bypass.
        Surg Obes Relat Dis. 2017; 13: 243-248
        • Capella J.F.
        • Capella R.F.
        Gastro-gastric fistulas and marginal ulcers in gastric bypass procedures for weight reduction.
        Obes Surg. 1999; 9 (discussion 8): 22-27
        • O'Brien C.S.
        • Wang G.
        • McGinty J.
        • Agenor K.K.
        • Dutia R.
        • Colarusso A.
        • et al.
        Effects of gastrogastric fistula repair on weight loss and gut hormone levels.
        Obes Surg. 2013; 23: 1294-1301
        • Salimath J.
        • Rosenthal R.J.
        • Szomstein S.
        Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula.
        Surg Endosc. 2009; 23: 2591-2595
        • Okorji L.M.
        • Nimeri A.
        Laparoscopic handsewn gastrojejunostomy revision of gastrojejunal anastomosis with takedown of gastro-gastric fistula.
        Obes Surg. 2022; 32: 1403-1404
        • Tsai C.
        • Kessler U.
        • Steffen R.
        • Merki H.
        • Zehetner J.
        Endoscopic closure of gastro-gastric fistula after gastric bypass: a technically feasible procedure but associated with low success rate.
        Obes Surg. 2019; 29: 23-27
      1. American Society of Metabolic and Bariatric Surgery Estimates [cited 2022 Jun 24].
        (Available from:)

      Linked Article