Antoine Guillaud1, David Moszkowicz2, Marius Nedelcu3, Aurélien Caballero-Caballero1, Lionel Rebibo4, Fabian Reche1, Julio Abba1, Catherine Arvieux5. 1. Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France. 2. Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, University Paris 5, Hôpital Européen Georges Pompidou, Paris, France. 3. Department of Surgery, Saint Eloi Hospital-CHRU Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier Cedex 5, France. 4. Department of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France. 5. Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France. CArvieux@chu-grenoble.fr.
Abstract
BACKGROUND: Gastrobronchial fistula (GBF) is a complication of esophageal, splenic, or antireflux surgeries and was recently described as a complication of bariatric surgery. Our aim was to study all cases of GBF after laparoscopic sleeve gastrectomy (LSG) managed in five French university bariatric centers in order to establish the incidence and to evaluate the different treatments of this complication. METHODS: We retrospectively studied 13 patients which developed GBF after LSG performed between March 2007 and August 2012. Patients were separated into two groups: patients who had early gastric fistula which has evolved into a GBF (group 1) and patients who had a late gastric fistula, either directly GBF or a late gastric fistula evolved in GBF (group 2). RESULTS: Group 1 consisted of five patients and group 2 of eight patients. All patients were undernourished at diagnosis. Management of GBF was a combined thoraco-abdominal surgery with gastrojejunal anastomosis (n = 5) or total gastrectomy (n = 1), multiple endoscopic treatment and thoracic surgery (n = 3), an endobronchial valve (n = 1), total gastrectomy and thoracic drainage (n = 1), and transorificial intubation with thoracic surgery or drainage (n = 2). There was no mortality. All GBF healed. CONCLUSIONS: GBF after LSG is a serious complication which is not anecdotal. Most of the early gastric fistulas occuring after LSG become chronic and can evolve into a GBF. Surgical approach is an effective treatment. Endobronchial valve is a novel alternative.
BACKGROUND: Gastrobronchial fistula (GBF) is a complication of esophageal, splenic, or antireflux surgeries and was recently described as a complication of bariatric surgery. Our aim was to study all cases of GBF after laparoscopic sleeve gastrectomy (LSG) managed in five French university bariatric centers in order to establish the incidence and to evaluate the different treatments of this complication. METHODS: We retrospectively studied 13 patients which developed GBF after LSG performed between March 2007 and August 2012. Patients were separated into two groups: patients who had early gastric fistula which has evolved into a GBF (group 1) and patients who had a late gastric fistula, either directly GBF or a late gastric fistula evolved in GBF (group 2). RESULTS: Group 1 consisted of five patients and group 2 of eight patients. All patients were undernourished at diagnosis. Management of GBF was a combined thoraco-abdominal surgery with gastrojejunal anastomosis (n = 5) or total gastrectomy (n = 1), multiple endoscopic treatment and thoracic surgery (n = 3), an endobronchial valve (n = 1), total gastrectomy and thoracic drainage (n = 1), and transorificial intubation with thoracic surgery or drainage (n = 2). There was no mortality. All GBF healed. CONCLUSIONS: GBF after LSG is a serious complication which is not anecdotal. Most of the early gastric fistulas occuring after LSG become chronic and can evolve into a GBF. Surgical approach is an effective treatment. Endobronchial valve is a novel alternative.
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