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Preliminary report: search for a transgastric approach for managing gastrogastric fistulas
Gonzalo Torres-Villalobos1, Daniel B Leslie, David Hunter
1Department of Surgery, University of Minnesota, 420 Delaware Street, MMC 290, Minneapolis, MN 55455, USA. torresvgm@yahoo.com.mx
Background:
Revision surgery to eliminate a gastrogastric fistula (GGF) is often associated with high morbidity.
Methods:
This report describes a percutaneous transgastric approach for revision surgery in three patients with GGF using a transgastric, totally extraperitoneal approach.
Results:
The access was performed successfully in all the patients. There were no intraoperative complications, and the patients had an uneventful recovery. One patient had a recurrence 8 months after the procedure but had achieved satisfactory weight loss during the period. We were able to perform a second percutaneous transgastric repair. The second patient showed an asymptomatic recurrence of the fistula, which was later completely repaired. The third patient has had moderate weight loss.
Conclusions:
Although current results are not optimal, we believe that this approach could represent an alternative for patients with a hostile abdomen or in whom co-morbidities comprise a prohibitive factor. Further experience, technical improvements, and longer follow-up are needed to evaluate and optimize this approach and evaluate its potential use in other surgical areas.
