QMVAPJDAWL Performance of A Robotic Assisted Laparoscopic Gastro-Gastric Fistula Takedown

Document Type

Abstract

Publication Date

6-18-2025

Abstract

Ellen Pekar University of Pennsylvania; John Fam Tower Health/Drexel University Introduction: A 65 yo female with history of open roux-en-y gastric bypass in 2005 presented with chronic epigastric pain. The patient reported a history of chronic marginal ulcers and was on BID dosing of her PPI with continued symptoms. Method: EGD performed showing healing marginal ulcers and a 5 mm gastro-gastric fistula. Preoperative CT scan obtained confirming diagnosis. Decision was made to undergo G-G fistula takedown. Access obtained in the supraumbilical position with a 5mm Optiview trocar. 12 mm port placed to the right of the umbilicus. 8 mm port placed in the right lateral abdomen. Two 8 mm ports placed in the left side of the abdomen. 5mm port upsized to 8 mm port. Extensive adhesiolysis performed taking down adhesions from pouch, liver, and gastrojejunostomy to surrounding structures. EGD performed confirming anatomy. Roux limb divided distal to gastrojejunostomy using white load on a sureform stapler. Short gastric vessels ligated. Gastric remnant transected at antrum using two blue loads. Pouch transected proximal to gatrojejunostomy using a blue load. Two layer handsewn anastomosis with 2-0 stratafix created between roux limb and gastric pouch. Leak test negative. Gastric remnant removed. Results: Patient doing well postoperatively with resolution of epigastric pain 41 days after surgery. Conclusion: A robotic laparoscopic revision with excision of gastrojejunostomy, partial gastrectomy, and takedown of gastro-gastric fistula is an effective method for dealing with gastro-gastric fistula after previous Roux-en-y gastric bypass.

Publication Title

Surgery for Obesity and Related Diseases

Volume

21

Issue

6 Supplement

First Page

S121

Last Page

S121

Comments

American Society for Metabolic and Bariatric Surgery (ASMBS) Annual Meeting 2025 held 2025-04-12 to 2025-04-15 in Chicago, IL, USA.

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