• Four patients had complicated gastric and duodenal fistulas. In each patient, factors including marked inflammation and dense adhesions made dissection and mobilization difficult and hazardous. As a result, the standard recommended management of the fistulas was impossible. In each of these patients a Roux-en-Y operation was used successfully as an alternative procedure to seal the fistula. A successful outcome was experienced in each patient.
(Arch Surg 1981;116:614-617)