Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula

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

“…Our experience in laparoscopy represents only a few patients undergoing this type of surgery and is not in accordance with some already published series where laparoscopy appeared feasible and well tolerated [12,15,16,21]. In the present study, a laparotomy was systematically required (laparoscopy was attempted in 3 patients) because of severe adhesions, multiple fistulous sites, and the risk of a hazardous dissection (severe fibrosis).…”

“…The mean length of stay of 43 days is long compared with other studies [16,20,21], but these patients represent the initial experience of the department; the nonstandardized postoperative management (initial experience), together with the important rate of complications (50%), including 3 postoperative fistulas (median healing time 41 mo), can explain this prolonged length of stay.…”

“…The technical difficulties 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 Table 2 Clinical characteristics before a total gastrectomy for a chronic fistula from tissue changes, caused by the chronic inflammation described by the senior surgeons who operated on the 12 patients, precluded us using a laparoscopic approach for such an indication. Ramos et al [21] presented promising results of 12 laparoscopic total gastrectomies for chronic fistula after sleeve gastrectomy, with efficacy and safety profile of the procedure; however, the absence of patients' preoperative data (history, preoperative general status) does not allow the comparison of their series to complex cases. In the literature, resective surgery in obese patients is extremely mutilating but is required as the last resort in some cases, with the choice of surgical technique depending of the preoperative findings [3,21,22].…”

“…Ramos et al [21] presented promising results of 12 laparoscopic total gastrectomies for chronic fistula after sleeve gastrectomy, with efficacy and safety profile of the procedure; however, the absence of patients' preoperative data (history, preoperative general status) does not allow the comparison of their series to complex cases. In the literature, resective surgery in obese patients is extremely mutilating but is required as the last resort in some cases, with the choice of surgical technique depending of the preoperative findings [3,21,22]. However, conservative approaches have been described and appear feasible [12,[14][15][16].…”

Splenic abscess with portal venous gas caused by intrasplenic migration of an endoscopic double pigtail drain as a treatment of post–sleeve gastrectomy fistula

“…The present case report suggests the need for a closer radiological follow-up in patients treated with double pigtail drain who may require endoscopic removal when migration occurs. Furthermore in chronic staple line leak with distal gastric stenosis, early revisional surgery with gastrectomy and conversion to a ϰ Roux-en-Y gastric bypass, may be the most effective option, resulting in high rate of resolution and fewer complications at experienced centers [5,10]. …”