Robotic takedown of gastro-gastric fistula with revision of gastric bypass and reconstruction of gastrojejunostomy

ABSTRACT: A 38-year-old female presented with chronic abdominal pain and nutritional decline due to a gastro-gastric fistula (GGF) following Roux-en-Y gastric bypass. Multiple endoscopic interventions, including OverStitch, fibrin sealant and over-the-scope clip (OTSC) placement, failed to close the fistula. Pre-operative imaging and endoscopy confirmed a patent gastrojejunostomy and an 8-mm GGF with embedded OTSC. A robotic approach was undertaken. Dense adhesions were lysed, and the fistula was dissected and excised. The OTSC was identified and removed intraoperatively. The gastrojejunostomy-fistula complex was resected, and a new hand-sewn gastrojejunostomy was created robotically. The remnant stomach was resected. Endoscopy confirmed an intact anastomosis and a negative leak test. The patient tolerated oral intake on post-operative day one and was discharged on the same day. At 6 months, she remained asymptomatic with stable nutritional status. This case highlights the role of robotic surgery in managing refractory GGF, particularly after failed endoscopic interventions.