Background

Patient is a 63-year-old female with past medical history of hypertension, hyperlipidemia, asthma and history of obesity for which she underwent a vertical banded gastroplasty (VBG) several years ago and subsequently underwent a revision of the VBG to a Roux-en-Y gastric bypass in 2020. The patient presented to our clinic with nausea, vomiting, halitosis, regurgitation, dysphagia and weight regain (body mass index of 37). Preoperative imaging included an upper gastrointestinal series and a computed tomography of the abdomen and pelvis with oral contrast which revealed passage of contrast through a gastrogastric fistula into the gastric remnant. We believed the gastrogastric fistula was a consequence of the VBG and was not adequately addressed on her first revisional surgery. Preoperative esophagogastroduodenoscopy confirmed the gastrogastric fistula and additionally found an acute marginal ulcer. The patient was taken to the operating room for a robotic assisted laparoscopic revision of the Roux-en-Y gastric bypass. The video describes the resection of the previous gastrojejunostomy along with the resection of the gastrogastric fistula and creation of a new gastrojejunostomy. The patient had an uneventful recovery, was discharged on postoperative day 2 and was last seen at 9 months postoperative doing well and with a body mass index of 31.