A gastro-gastric fistula is a complication of gastric bypass surgery that causes pain, reflux, weight gain, and peptic ulcer disease. The management of gastro-gastric fistulae can be a complicated algorithm. We demonstrate a laparoscopic approach to the management of gastro-gastric fistulae that removes the fistula by removing the portion of the gastric remnant adjacent to the pouch. This prevents unnecessary dissection, which would otherwise be needed to identify the fistulous tract intraoperatively.

In the video, an initial lysis of adhesions is followed by the dissection of the gastric pouch and the gastric remnant. The greater omentum is dissected off of the greater curvature of the stomach. An intraoperative endoscopy is performed, which localizes the gastro-gastric fistula. The remnant gastrectomy is then performed by dividing the stomach from the greater curvature towards the pouch. The resection then turns cephalad, and the remnant is divided from the pouch. It is this step, which actually divides and removes the fistula. A second endoscopy reveals the resolution of the fistula.

This procedure not only cures gastro-gastric fistulae, but it also prevents recurrence by removing the portion of the remnant stomach adjacent to the gastric pouch.