Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement

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

“…The support period after discovery of the leak was highly variable, with a mean time (range) from discovery of the GL to reoperation of 14.4 months (5-44 mo) [13]. One study proposed systematic reoperation 3 months after treatment failure [33]. On the basis of the authors' experience and statistical analysis, reoperation 120 days after discovery of the GL is now proposed.…”

Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects

“…In our experience, when a leak was diagnosed early and the site of the leak, the viability of the conduit, and the clinical status of the patient allowed for primary closure, a laparoscopy with intent to suture the defect in combination with adequate drainage is performed. In the event of unsuccessful primary closure, a partly covered metallic stent (Ultraflex, 18 9 150 mm, Boston Scientific, Galway, Ireland) should be endoscopically deployed to cover the leak [4]. When an abdominal collection still exists after the primary operation, percutaneous drainage guided by a computed tomography (CT) scan is performed before undergoing any other procedure.…”

“…Roux limb placement can offer an immediate or delayed healing of the defect [4]. A laparoscopic apposition of a Roux-en-Y limb without mucosa-to-mucosa anastomosis has also been described in one patient to drain the undebrided fistula defect can effectively treat chronic leaks at the EGJ after LSG [6].…”

ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management

“…Multiple surgical procedures have been described for management of non-healing fistulas. They include laparoscopic or open gastrojejunal anastomosis [86][87][88][89][90][91][92], conversion to GB [88,93], total gastrectomy with esophagojejunostomy [58,88,[93][94][95] and T-tube placement [96,97]. With a total of approximately 70 cases reported, no reliable conclusions can be drawn in terms of post-operative outcomes of these various treatment strategies.…”