A thoracoabdominal approach for gastrobronchial fistula repair post complicated laparoscopic sleeve gastrectomy

AlShammari, Abdullah; Alam, Sreyoshi Fatima; Ahmed, Mohammed Hussein; Alkattan, Khaled

doi:10.1016/j.ijscr.2018.03.031

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…Early TGAFs mainly involving esophageal anastomosis leakage, including mechanical fistulas, are usually discovered within the first 2 days after surgery, while classic ischemia anastomosis leakages commonly appear 5 to 6 days postoperation. 11 They usually form between the adjacent stomach wall due to ischemic necrosis caused by stomach staples. The excessive separation and destruction of the mediastinal blood supply of the trachea and main bronchi also contribute to the formation of fistulas.…”

Section: Discussionmentioning

confidence: 99%

“…12 Late TGAFs mostly occur as a result of non-healing ulcers of the gastric conduit, anastomotic leaks, inflammation, infection, iatrogenic trauma, radiotherapy, or tumor recurrence after esophagectomy. 11,12 The process of late fistula formation may involve perforation of the stomach wall by the ulcer of the gastric conduit, and subsequent damage to the tracheal wall by the gastric fluid. Alternatively, the stomach tissue may not be able to tolerate the dosage of radiation for esophageal cancer, resulting in fistula formation as a result of radiation injury.…”

Section: Discussionmentioning

confidence: 99%

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Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Wang

Chen

et al. 2020

J Int Med Res

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Background Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF. Methods We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms “gastric airway fistula”, “gastrotracheal fistula”, “gastrobronchial fistula”, “tracheogastric fistula”, “bronchogastric fistula”, “esophageal cancer”, and “esophagectomy”. Result Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively. Conclusion TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Wang

Chen

et al. 2020

J Int Med Res

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“…The therapeutic approach is tailored on the clinical conditions of the patient. In the absence of sepsis, a more conservative approach may be attempted [8].…”

Section: Discussionmentioning

confidence: 99%

“…Utmost importance is reserved to the prevention of sepsis with the use of wide-spectrum antibiotics, eventually associated with a careful percutaneous drainage of the subphrenic abscess, given the risk to create a iatrogenic fistula by accidentally puncturing the inflamed diaphragm or leaving for several days a drainage catheter. Nutritional status should be pre-operatively optimized through TPN, nasojejunal tube or jejunostomy [8]. Surgical treatment should be aggressive and include a management of gastric leak through a partial or total gastrectomy, a pulmonary resection and a diaphragmatic reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The thoracic step involves a left inferior lobectomy or a segmental lung resection, generally through a left posterolateral thoracotomy, albeit transdiaphragmatic approaches have been described, as in our case. Different materials have been employed for the reconstruction of the diaphragmatic surface after fistulectomy and complete debridement of the eroded tissue: simple suture, omental patch, biologic prosthesis or autologous tissue such as latissimus dorsi flap and serratus anterior flap [8]. Whenever possible, the totally abdominal transdiaphragmatic approach allows the surgeon to correctly deal with the fistula and the inferior pulmonary lobe and, at the same time, to avoid the postoperative morbidity connected with thoracotomy incision.…”

Section: Discussionmentioning

confidence: 99%

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Gastrobronchial Fistula After Re-Sleeve Gastrectomy: Case Report and Review of Literature

Bencivenga¹,

Giacopuzzi²,

Zenzaro³

et al. 2019

GSCR

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Introduction: Gastro-bronchial fistula (GBF) is a rare and challenging complication of sleeve gastrectomy as it is the result of a chronic gastric leak and subsequent long-standing sub-phrenic abscess. In this article we report the first case of GBF after a re-sleeve gastrectomy. Case Presentation: a 42-years-old patient was admitted to our Unit because of the arise of sepsis, hypothension and cough with expectoration of enteral nutrition. The patient had a history of sleeve (2010) and re-sleeve gastrectomy (2017) for weight regain. On admission radiological signs of consolidation of the left pulmonary lobe and, after the swallowing of oral contrast, a little backward trans-diaphragmatic opacification of the main bronchus was described. An open total gastrectomy with a trans-abdominal atypical lower pulmonary lobe resection were performed. A post-operative ERAS protocol was adopted, and the patient was discharged in POD 9 in good conditions, after an uneventful recovery and feeding per os. Conclusions: To our knowledge this is the first case of a GBF after a re-sleeve gastrectomy, more evidences are needed before routinely advice a re-sleeve gastrectomy after a failed sleeve gastrectomy. Indeed, given that in revisional bariatric surgery the risk of gastric leak may be higher due to a greater tension applied on the staple line, the incidence of rare but serious complications such GBF may consequently increase.

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Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options

et al. 2020

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This study aimed to establish the optimal diagnostic and treatment algorithm for the management of Gastric Fistula in the Chest (GFIC) after Sleeve Gastrectomy (SG) through a systematic review of published cases. A multi-database search was performed which produced 1182 results, of which twenty-six studies were included in this systematic review. The initial presentation included subphrenic collections, leaks, or (recurrent) pneumonia with associated symptoms such as persistent cough, fever and/or dyspnoea.Computed Tomography (CT) scan in combination with either Upper Gastrointestinal series (UGI) or an Esophagogastroduodenoscopy (EGD) was used to adequately diagnose the fistulas. Initial treatment was either with clips and/or clips and stents that were placed endoscopically. When unsuccessful in majority of the cases, the surgical treatment consisted in a total gastrectomy and Roux-en-Y esophagojejunostomy in a laparoscopic or open fashion.

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A thoracoabdominal approach for gastrobronchial fistula repair post complicated laparoscopic sleeve gastrectomy

Abstract: HighlightsThere has been an increase in bariatric surgery.Gastrobronchial fistula is one of the newly identified severe complications.Medical literature is yet to come up with a consensus on management.We aim to contribute to a better understanding and add to the managerial approach.

Cited by 3 publications

References 5 publications

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review

Gastrobronchial Fistula After Re-Sleeve Gastrectomy: Case Report and Review of Literature

Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options

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