Imed Ben Amor1, Tarek Debs2, Giorgio Dalmonte1,3, Radwan Kassir4, Patrick Baqué1, Niccolo Petrucciani5, Jean Gugenheim1. 1. Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France. 2. Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, 151 Route de Saint-Antoine, 06200, Nice, France. dr.debs@hotmail.com. 3. Unit of Clinical Surgery, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy. 4. Department of Bariatric Surgery, CHU Félix Guyon, Saint-Denis, La Réunion, France. 5. Division of Digestive Surgery, Henri Mondor University Hospital, UPEC, Creteil, France.
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy represents the most performed bariatric procedure in France. Staple line leak is the major short-term complication of the procedure. Patients with persistent fistula after sleeve gastrectomy, after failure of endoscopic and radiological treatment, are candidates for salvage surgery. Laparoscopic fistulo-jejunostomy (LRYFJ) represents a surgical option to treat persistent fistula post sleeve. METHODS: The case of a 46-year-old woman, with persistent fistula after sleeve gastrectomy, undergoing laparoscopic fistula-jejunostomy is presented. The patient developed an abdominal abscess 2 months after sleeve gastrectomy, treated with radiological drainage. Upper gastrointestinal endoscopy was performed for pigtail insertion. Three months later, the fistula was persistent and salvage surgery was proposed. At surgery, the pigtail drain and the fistula orifice were identified with careful dissection. Then a manual Roux-en-Y fistula-jejunal anastomosis and a mechanical jejuno-jejunal anastomosis are performed. RESULTS: The postoperative course was uneventful. CONCLUSIONS: LRYFJ for chronic fistula after sleeve gastrectomy is safe and effective. However, it remains a challenging procedure and should be reserved for specialized centers.
BACKGROUND: Laparoscopic sleeve gastrectomy represents the most performed bariatric procedure in France. Staple line leak is the major short-term complication of the procedure. Patients with persistent fistula after sleeve gastrectomy, after failure of endoscopic and radiological treatment, are candidates for salvage surgery. Laparoscopic fistulo-jejunostomy (LRYFJ) represents a surgical option to treat persistent fistula post sleeve. METHODS: The case of a 46-year-old woman, with persistent fistula after sleeve gastrectomy, undergoing laparoscopic fistula-jejunostomy is presented. The patient developed an abdominal abscess 2 months after sleeve gastrectomy, treated with radiological drainage. Upper gastrointestinal endoscopy was performed for pigtail insertion. Three months later, the fistula was persistent and salvage surgery was proposed. At surgery, the pigtail drain and the fistula orifice were identified with careful dissection. Then a manual Roux-en-Y fistula-jejunal anastomosis and a mechanical jejuno-jejunal anastomosis are performed. RESULTS: The postoperative course was uneventful. CONCLUSIONS: LRYFJ for chronic fistula after sleeve gastrectomy is safe and effective. However, it remains a challenging procedure and should be reserved for specialized centers.
Entities:
Keywords:
Fistulas post sleeve; Roux-En-Y fistulo-jejunostomy; Sleeve gastrectomy; Surgical technique
Authors: Carlos Serra; Aniceto Baltasar; Luis Andreo; Nieves Pérez; Rafael Bou; Marcelo Bengochea; Juan José Chisbert Journal: Obes Surg Date: 2007-07 Impact factor: 4.129