BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular bariatric procedure. A chronic fistula at the esophago-gastric junction (EGJ) is a rare but life-threatening complication of this procedure whose causes are still unclear and management is still controversial. METHODS: A 41-year-old woman with a body mass index (BMI) of 38 developed an EGJ leak 6 days post-LSG. Despite initial control with conservative measures, the leak persisted and resulted in a left pleural abscess and a broncho-pleural fistula requiring thoracotomy with resection of the abscessed lung parenchyma. Endoscopic and drainage procedures failed to prevent subdiaphragmatic recurring collection due to the persistent fistula. Nineteen months after LSG, a Roux limb was placed on the EGJ and sutured side to side around the fistula defect, without mucosa-to-mucosa anastomosis. RESULTS: The postoperative course was uneventful and, 20 months later (39 months post-LSG), the patient is well with a BMI of 27. CONCLUSIONS: Laparoscopic apposition of a Roux-en-Y limb without mucosa-to-mucosa anastomosis as an efferent path to drain the undebrided fistula defect can effectively treat chronic leaks at the EGJ after LSG.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular bariatric procedure. A chronic fistula at the esophago-gastric junction (EGJ) is a rare but life-threatening complication of this procedure whose causes are still unclear and management is still controversial. METHODS: A 41-year-old woman with a body mass index (BMI) of 38 developed an EGJ leak 6 days post-LSG. Despite initial control with conservative measures, the leak persisted and resulted in a left pleural abscess and a broncho-pleural fistula requiring thoracotomy with resection of the abscessed lung parenchyma. Endoscopic and drainage procedures failed to prevent subdiaphragmatic recurring collection due to the persistent fistula. Nineteen months after LSG, a Roux limb was placed on the EGJ and sutured side to side around the fistula defect, without mucosa-to-mucosa anastomosis. RESULTS: The postoperative course was uneventful and, 20 months later (39 months post-LSG), the patient is well with a BMI of 27. CONCLUSIONS: Laparoscopic apposition of a Roux-en-Y limb without mucosa-to-mucosa anastomosis as an efferent path to drain the undebrided fistula defect can effectively treat chronic leaks at the EGJ after LSG.
Authors: Manuel Ferrer Márquez; Manuel Ferrer Ayza; Ricardo Belda Lozano; María del Mar Rico Morales; Jose Miguel García Díez; Ricardo Belda Poujoulet Journal: Obes Surg Date: 2010-09 Impact factor: 4.129
Authors: G Casella; E Soricelli; M Rizzello; P Trentino; F Fiocca; A Fantini; F M Salvatori; N Basso Journal: Obes Surg Date: 2009-04-21 Impact factor: 4.129
Authors: Simon van de Vrande; Jacques Himpens; Haicam El Mourad; Randy Debaerdemaeker; Guido Leman Journal: Surg Obes Relat Dis Date: 2013-01-16 Impact factor: 4.734