Georges Bou Nassif1, Luca Paolino2, Andrea Lazzati2,3. 1. Department of General Surgery, Center Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000, Créteil, France. george.bn@hotmail.com. 2. Department of General Surgery, Center Hospitalier Intercommunal de Créteil, 40 Avenue de Verdun, 94000, Créteil, France. 3. INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Université Paris Descartes, F-75006, Paris, France.
Abstract
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has become one of the most popular bariatric surgeries worldwide. However, complications related to the stapler line can be very serious. Among several challenging post-LSG complications, fistula is the most feared. Its management can be very challenging and chronic. In case of chronic fistula and failure of surgical, endoscopic, and radiological treatment, total gastrectomy with esojejunal anastomosis (RYOJ) can be considered as an effective solution. We describe in this video the steps of our laparoscopic technique. METHODS: We have performed a total gastrectomy with RYOJ in a particular patient with chronic and persisting gastric fistula 9 months after LSG. The body mass index (BMI) was initially 50 kg/m2 at the time of the LSG against 31 kg/m2 on the day of the RYOJ. RESULTS: The postoperative course was uneventful. An upper GI series was done at 1 week and 1 month postoperatively without any abnormality. The patient was evaluated clinically and biologically at 1, 3, and 6 months later on with no evidence of dysphasia or biological abnormality. CONCLUSION: RYOJ in our particular case was efficient. However, longer series and longer follow-up are needed to confirm the effectiveness of this rescue procedure.
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has become one of the most popular bariatric surgeries worldwide. However, complications related to the stapler line can be very serious. Among several challenging post-LSG complications, fistula is the most feared. Its management can be very challenging and chronic. In case of chronic fistula and failure of surgical, endoscopic, and radiological treatment, total gastrectomy with esojejunal anastomosis (RYOJ) can be considered as an effective solution. We describe in this video the steps of our laparoscopic technique. METHODS: We have performed a total gastrectomy with RYOJ in a particular patient with chronic and persisting gastric fistula 9 months after LSG. The body mass index (BMI) was initially 50 kg/m2 at the time of the LSG against 31 kg/m2 on the day of the RYOJ. RESULTS: The postoperative course was uneventful. An upper GI series was done at 1 week and 1 month postoperatively without any abnormality. The patient was evaluated clinically and biologically at 1, 3, and 6 months later on with no evidence of dysphasia or biological abnormality. CONCLUSION: RYOJ in our particular case was efficient. However, longer series and longer follow-up are needed to confirm the effectiveness of this rescue procedure.
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: A Pequignot; D Fuks; P Verhaeghe; A Dhahri; O Brehant; E Bartoli; R Delcenserie; T Yzet; J-M Regimbeau Journal: Obes Surg Date: 2012-05 Impact factor: 4.129