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Background

Gastro-gastric fistula (GGF) formation following Roux-en-Y gastric bypass surgery (RYGB) is a rare complication that could inhibit weight loss, lead to weight regain, and hinder improvements in obesity-related chronic diseases (ORCD). The effect of GGF revision (GGFR) on ORCD is unknown. This study estimates the rate of type-2 diabetes (T2DM) remission in those with T2DM at time of GGFR and evaluates whether weight loss and DiaRem scores are associated with T2DM remission.

Methods

Retrospective review was conducted on T2DM patients that had RYGB and GGFR surgeries occurring between 2003-2019. DiaRem scores at RYGB and GGFR and changes in body weight were compared between those with and without post-GGFR T2DM remission using two-sample t-tests.

Results

There were 20 T2DM patients with GGFR between 1 and 14 years after RYGB (median = 4.9 years). A mean age of 58.7 including 75% females and 35% on insulin medication at the time of revision. At one-year after GGFR 25% (n=5) patients achieved T2DM remission. The total mean percent weight loss from RYGB to GGFR was 20.1% and increased to 28.8% at one-year after GGFR. Post-GGFR diabetes remission was associated with lower pre-GGFR DiaRem score (p<0.0001), but not with DiaRem at RYGB (p=0.615), weight loss from RYGB to GGFR (p=0.316), or weight loss 1-year postoperatively following GGFR (p=0.979).

Conclusions

Diabetes remission following GGFR is achievable, especially for those with lowerHbA1c, younger age, and not using insulin medication. Further studies evaluating obesity-related chronic disease remission following bariatric primary and revisional surgeries are needed.