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Laparoscopic Total Gastrectomy with Roux-Y Esophagojejunostomy for Chronic Gastric Fistula After Laparoscopic Sleeve Gastrectomy

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Abstract

Laparoscopic sleeve gastrectomy is a restrictive operation with hormonal elements that is rapidly gaining popularity. The most feared complication of the procedure is a staple line leak. The treatment of staple line leakage depends on timing and clinical and anatomical considerations. If leakage persists and transforms into a chronic fistula, a definitive surgical procedure is required. In cases where the fistula originates close to the esophagogastric junction, the surgical possibilities are limited and one treatment option is total gastrectomy with esophagojejunal anastomosis. We report a case series of four patients with chronic fistulae, who failed conservative treatment and required total gastrectomy. Their average length of hospital stay was 8.7 days (range, 5–15 days), without conversions, leaks, or other complications. In experienced hands, total gastrectomy is feasible by laparoscopic techniques and should be performed soon after the fistula is established.

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References

  1. Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery. Position statement: sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2007;3:573–6.

    Article  Google Scholar 

  2. Deitel M, Ros C, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg. 2008;18:48746.

    Google Scholar 

  3. Rosenthal R. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of 12,000 cases. Surg Obes Relat Dis 2012; 8–19.

  4. Casella G, Soricelli E, Rizello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.

    Article  CAS  PubMed  Google Scholar 

  5. Papavramidis TS, Kotzampassi K, Kotidis E, Eleftheriadis EE, Papavramidis ST. Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch. J Gastroenterol Hepatol. 2008;23:1802–5.

    Article  PubMed  Google Scholar 

  6. Akhras J, Tobi M, Zagnoon A. Endoscopic fibrin sealant injection with application of hemostatic clips: a novel method of closing a refractory gastrocutaneous fistula. Dig Dis Sci. 2005;50:1872–4.

    Article  PubMed  Google Scholar 

  7. Baltasar A, Serra C, Pérez N, et al. Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg. 2005;15:124–8.

    Article  Google Scholar 

  8. Salinas A, Baptista A, Santiago E, et al. Self-expanding metal stents to treat gastric leaks. Surg Obes Related Dis. 2006;2:570–2.

    Article  Google Scholar 

  9. Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with a coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.

    Article  PubMed  Google Scholar 

  10. Galizia G, Napolitano V, Castellano P, et al. The over-the-scope-clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg. doi:10.1007/s11605-012-1862

  11. Aly A, Lim HK. The use of over the scope clip (OTSC) device for sleeve gastrectomy leak. J Gastrointest Surg. 2013;17(3):606–8.

    Article  PubMed  Google Scholar 

  12. El Mourad H, Himpens J, Verhofstadt J. Stent treatment for fistula after obesity surgery: results in 47 consecutive patients. Surg Endosc. 2013;27(3):808–16.

    Article  PubMed  Google Scholar 

  13. Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, et al. Non surgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(7):821–6.

    Article  CAS  PubMed  Google Scholar 

  14. Court I, Wilson A, Benotti P, Szomstein S, Rosenthal R. T-tube gastrostomy as a novel approach for distal staple line disruption after sleeve gastrectomy for morbid obesity: case report and review of the literature. Obes Surg. 2010;20(4):519–22.

    Article  PubMed  Google Scholar 

  15. Baltasar A, Serra C, Bengochea M, Bou R, Andreo L. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4:759–63.

    Article  PubMed  Google Scholar 

  16. Van de Vrande S, Himpens J, El Mourad H, Debaerdemaeker R, Leman G. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis. 2013

  17. Suter M, Ralea S, Millo P, Allé JL. Laparoscopic Roux-en-Y Gastric bypass after failed vertical banded gastroplasty: a multicenter experience with 203 patients. Obes Surg. 2012;22(10):1554–61.

    Article  CAS  PubMed  Google Scholar 

  18. Serra C, Baltasar A, Pérez N, et al. Total gastrectomy for complications of the duodenal switch with reversal. Obes Surg. 2006;16:1082–6.

    Article  PubMed  Google Scholar 

  19. Moszkowicz D, Arienzo R, Khettab I, Rahmi G, Zinzindohoué F, Berger A, et al. Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obes Surg. 2013;23(5):676–86.

    Article  PubMed  Google Scholar 

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The authors declare no conflict of interest.

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Correspondence to Almog Ben Yaacov.

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Ben Yaacov, A., Sadot, E., Ben David, M. et al. Laparoscopic Total Gastrectomy with Roux-Y Esophagojejunostomy for Chronic Gastric Fistula After Laparoscopic Sleeve Gastrectomy. OBES SURG 24, 425–429 (2014). https://doi.org/10.1007/s11695-013-1162-1

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