Ahmad Assalia1, Anat Ilivitzki2, Amos Ofer2, Alain Suissa3, Elias Manassa4, Iyad Khamaysi3, Ahmad Mahajna4. 1. Department of General Surgery, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: a_assalia@rambam.health.gov.il. 2. Department of Radiology, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 3. Department of Gastroenterology, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 4. Department of General Surgery, Rambam Health Care Campus and the Rappaport faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality. OBJECTIVES: To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG. SETTING: University hospital, Israel. METHODS: Twenty-four morbidly obese patients (mean age = 42.2 yr, mean body mass index = 42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage. RESULTS: There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20-46). CONCLUSIONS: Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality. OBJECTIVES: To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG. SETTING: University hospital, Israel. METHODS: Twenty-four morbidly obesepatients (mean age = 42.2 yr, mean body mass index = 42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage. RESULTS: There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20-46). CONCLUSIONS: Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG.