Matthieu Bruzzi1,2,3,4, Leïla M'Harzi5,6, Tigran Poghosyan5,6,7, Salma El Batti8,7, Franck Zinzindohoué6,7, Jean-Marc Chevallier8,5,6,7, Richard Douard8,5,6,7. 1. URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France. matthieu.bruzzi@aphp.fr. 2. INSERM 970, Équipe 2, PARCC, HEGP, Paris, France. matthieu.bruzzi@aphp.fr. 3. General and Digestive Surgery Unit, Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France. matthieu.bruzzi@aphp.fr. 4. Paris Descartes Faculty of Medicine, Paris, France. matthieu.bruzzi@aphp.fr. 5. INSERM 970, Équipe 2, PARCC, HEGP, Paris, France. 6. General and Digestive Surgery Unit, Georges Pompidou, AP-HP University Hospital, 20, Rue Leblanc, 75908, Paris Cedex 15, France. 7. Paris Descartes Faculty of Medicine, Paris, France. 8. URDIA Anatomie (EA4465), Paris Descartes Faculty of Medicine, Paris, France.
Abstract
PURPOSE: Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG. METHODS: Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017. RESULTS: A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula's termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage. CONCLUSIONS: Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.
PURPOSE:Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG. METHODS: Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017. RESULTS: A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula's termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage. CONCLUSIONS: Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.
Authors: Raul J Rosenthal; Alberto Aceves Diaz; Dag Arvidsson; Randal S Baker; Nicola Basso; Drake Bellanger; Camilo Boza; Haicam El Mourad; Michael France; Michel Gagner; Manoel Galvao-Neto; Kelvin D Higa; Jacques Himpens; Colleen M Hutchinson; Moises Jacobs; John O Jorgensen; Gregg Jossart; Muffazal Lakdawala; Ninh T Nguyen; David Nocca; Gerhard Prager; Alfons Pomp; Almino Cardoso Ramos; Raul J Rosenthal; Shashank Shah; Michel Vix; Alan Wittgrove; Natan Zundel Journal: Surg Obes Relat Dis Date: 2011-11-10 Impact factor: 4.734
Authors: Xabier de Aretxabala; Jorge Leon; Gonzalo Wiedmaier; Ivan Turu; Cristian Ovalle; Fernando Maluenda; Carolina Gonzalez; Jennifer Humphrey; Mabel Hurtado; Carlos Benavides Journal: Obes Surg Date: 2011-08 Impact factor: 4.129
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