Background

The video case presentation demonstrates the surgical resection of an acquired gastro-gastric fistula in a patient with a prior roux-en-Y gastric bypass. The patient developed severe gastrointestinal reflux disease (GERD) years after her bypass. On workup with upper endoscopy and contrast studies, a fistula between her gastric pouch and excluded stomach (gastric remnant) has developed. Closure of the fistula was attempted with an endoscopic clip, but was not successful. The patient then underwent surgical management of the gastro-gastric fistula as demonstrated in the video presentation. The surgical approach was made complex due to the presence of the endoscopic clip and ultimately due to difficulty developing a safe plane, the decision was made to perform an en-bloc resection of the fistula tract with the proximal gastric remnant and gastric pouch. The patient did well after the surgery and no longer has symptoms of GERD.