Bariatric postoperative fistula: a life-saving endoscopic procedure

Baretta, Giórgio Alfredo Pedroso; Campos, Josemberg Marins; Correia, Sércio Flavny Brandão de Menezes; Alhinho, Helga C. A. W.; Marchesini, João Batista; Lima, João Henrique Felício de; Neto, Manoel Galvão

doi:10.1007/s00464-014-3869-z

Cited by 69 publications

(51 citation statements)

References 16 publications

(19 reference statements)

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“…Ancillary treatment involves endoscopy, with implantation of a coated stent (CS) [3][4][5], a double pigtail stent (DPS) [6], or both [7] (depending on the series). Additional options include percutaneous radiologic drainage [8] or stricturotomy combined with endoscopic dilation [9,10].…”

mentioning

confidence: 99%

Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation

Rebibo

Bartoli

Dhahri

et al. 2016

Surgery for Obesity and Related Diseases

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mentioning

confidence: 99%

Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation

Rebibo

Bartoli

Dhahri

et al. 2016

Surgery for Obesity and Related Diseases

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“…Fistula orifices ≥10 mm in size have been reported to have more difficulty healing with stents compared to smaller fistulas [15]. In a recent review on endoscopic management of complications of bariatric surgery by Eisendrath and Deviere [8], the endoscopic approach to managing fistulas after bariatric surgery was associated with a success rate of over 80%.…”

Section: Discussionmentioning

confidence: 99%

Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas

Sousa

Ferreira

Coutinho

et al. 2018

GE Port J Gastroenterol

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Background and Aims: Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas. Methods: This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence. Results: The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4–145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1–10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15–72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50–205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence. Conclusions: A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically. Key Messages: Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.

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“…In our latest and recent experience, washout and internal drainage (with pigtails) of the residual cavity, followed by diversion (using a stent) and closure (using a clip or bioglue) [8,23], seem to reduce and limit the incidence of chronic fistulas (data not shown). Furthermore, other authors presented new algorithms (guided by the size of the fistulous site and the presence of stenosis or rotation of the gastric tube) and new endoscopic technics (pneumatic dilation and stricturotomy) that allow early control of the gastric fistula and reduce the need for surgery [24,25].…”

Section: Discussionmentioning

confidence: 99%

Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy

Bruzzi

Douard

Voron

et al. 2016

Surgery for Obesity and Related Diseases

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Bariatric postoperative fistula: a life-saving endoscopic procedure

Abstract: This novel endoscopic procedure is safe, feasible, and effective, avoiding re-operation, allowing early oral feeding and discharge.

Cited by 69 publications

References 16 publications

Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation

Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation

Fistula Recurrence: A Clinical Reality after Successful Endoscopic Closure of Laparoscopic Sleeve Gastrectomy Fistulas

Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy

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