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Metabolic Benefits of Gastrogastric Fistula (GGF) Repair after Roux-en-Y Gastric Bypass (RYGB)
Kassra Ehsan; Thomas J. Martin, MD; Eric G. Sheu, MD, PhD, FACS; Ali Tavakkoli, MD, FACS
Laboratory for Surgical and Metabolic Research, Brigham and Women’s Hospital, Boston, MA
Background: Postoperative GGF is a rare complication of RYGB associated with weight regain and diabetes recurrence. Though surgical repair improves weight loss, the metabolic benefits remain ill-defined.
Methods: Ten-year multicenter retrospective cohort study of RYGB patients with GGF who underwent laparoscopic repair. Anthropometric and metabolic parameters were abstracted pre- and post-RYGB, on GGF diagnosis, and following repair. Outcomes included total body weight loss (TBWL%), HbA1c, and de-escalation of antidiabetic therapy. Continuous variables were analyzed with standard or ratio paired t-test and linear regression.
Results: Thirty-four patients were included, of whom 30 (88.2%) were female with mean (SD) age of 52.2 (8.2) at GGF repair. Index RYGB was performed 16.9 (6.1) years earlier with 26 (76.5%) performed in open fashion. On diagnosis of GGF, 13 (38.2%) patients had type-2 diabetes (T2D) with mean HbA1c was 6.1 (0.7) and 11 (84.6%) required insulin. Median cumulative fistula size was 15 [8] mm. Post-repair, TBWL was -16.6% at 12 months (p<0.001). At 12 months, mean HbA1c reduction among diabetics was -0.66 (p=0.012) with 100% of patients liberated from insulin therapy. Cumulative fistula size was not correlated with postoperative TBWL% or HbA1c reduction.
Conclusion: Laparoscopic GGF repair following RYGB is associated with significant weight loss and metabolic improvements, irrespective of the size of fistula. In T2D patients on insulin, surgery led to de-escalation of insulin therapy along with an improvement in HbA1c. Our study supports the evaluation and repair of GGF of any size in appropriate candidates with weight regain or recurrent diabetes after RYGB.
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