Post Roux-en-Y Gastric Bypass Challenges: Gastrogastric Fistula After Marginal Ulcer Development.

Background: Gastrogastric fistula (GGF) is a rare complication following Roux-en-Y gastric bypass (RYGB). Various causative factors, including marginal ulcer (MU), can predispose to GGF development. Currently, no studies address surgical management of GGF after MU diagnosis. This study aims to report our experience in such cases.

Methods: A retrospective analysis of patients who underwent revisional surgery for GGF after MU diagnosis from 2016 and 2024. Patient demographics were collected, and peri- and postoperative outcomes were evaluated, including weight loss, complications, reinterventions, and MU recurrence.

Results: A total of 20 patients underwent revisional bariatric surgery (RBS) for resolution of GGF, with 13 (65%) treated under a robotic-assisted approach. The mean body mass index (BMI) at revision was 32.9 kg/m (± 6.5). Twelve (60%) patients also underwent gastrojejunostomy revision (GJ), while 6 (30%) patients had remnant partial gastrectomy. The 30-day readmission and reintervention rates were 25 and 20%, respectively. MU recurrence following RBS was 25%. At 24 months post-RBS, patients with obesity showed a mean %TWL of 21.1, while those without obesity, including 5 with GJ stenosis, had less pronounced weight loss, with weight maintenance and slight recurrent weight gain (%TWL: - 1.04).

Conclusions: GGF is a rare complication following RYGB and MU development. Given the high recurrence rate associated with medical and endoscopic treatments, surgical resolution is a feasible option to effectively address this complication. However, MU recurrence can still occur in approximately 25% of cases.