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

Bruzzi, Matthieu; Douard, Richard; Voron, Thibault; Berger, Anne; Zinzindohoué, Franck; Chevallier, Jean‐Marc

doi:10.1016/j.soard.2016.03.013

Cited by 27 publications

(12 citation statements)

References 25 publications

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“…As a major surgery mode, complete gastric resection is a salvage procedure for chronic leaks with inflammation, fibrosis, dissection, and adhesions, which cannot be cured through LRYEJ or RYGB. 135 GL can be prevented by gently handling tissues, reinforcing the staple line 136 (or overriding sutures or buttressing materials), performing procedures by experienced surgeons, 122,137 and performing proper traction on the stomach before firing 120 and proper bougie (≥40 Fr). 138 The use of pyloric Botulinum toxin (type A) injection during LSG can reduce the incidence of GL.…”

Section: Revisional Surgeries For Gastric Leakmentioning

confidence: 99%

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Li¹,

Jiao²,

Zhang³

et al. 2021

DMSO

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Bariatric surgery has become increasingly common due to the worldwide obesity epidemic. A shift from open to laparoscopic surgery, specifically, laparoscopic sleeve gastrectomy (LSG), has occurred in the last two decades because of the low morbidity and mortality rates of LSG. Although LSG is a promising treatment option for patients with morbid obesity due to restrictive and endocrine mechanisms, it requires modifications for a subset of patients because of weight regain and tough complications, such as gastroesophageal reflux, strictures, gastric leak, and persistent metabolic syndrome., Revision surgeries have become more and more indispensable in bariatric surgery, accounting for 7.4% in 2016. Mainstream revisional bariatric surgeries after LSG include Roux-en-Y gastric bypass, repeated sleeve gastrectomy, biliopancreatic diversion, duodenal switch, duodenal-jejunal bypass, one-anastomosis gastric bypass, single anastomosis duodeno-ileal bypass (SAID) and transit bipartition. This review mainly describes the revisional surgeries of LSG, including the indication, choice of surgical method, and subsequent effect.

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Section: Revisional Surgeries For Gastric Leakmentioning

confidence: 99%

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Li¹,

Jiao²,

Zhang³

et al. 2021

DMSO

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“…However, when conservative or surgical approaches fail and the leak persists for more than 12 weeks, becoming a chronic fistula and/or fistula involving neighboring organs like the spleen, bronchial tree, colon, and pleura, the most appropriate decisional algorithm and the best surgical treatment remain controversial. In this situation, three surgical techniques are commonly proposed: Roux-en-Y gastric bypass (RYGB), fistulojejunostomy (FJ), and total gastrectomy with esophagojejunal anastomosis (TG) [8,9]. The choice of the surgical technique and the timing of the operation seem largely to depend on surgical team experience and expertise.…”

Section: Key Pointsmentioning

confidence: 99%

“…Fistolojejunostomy and RYGB are more sparing tissue techniques with less risk of metabolic postoperative deficiencies [10]. TG is a more radical option that in particular conditions seems to be necessary in order to remove all fibrotic tissue and allow patient healing [9]. In the present study, we reviewed our experience concerning the treatment of chronic and complex fistulas after LSG treated with open total gastrectomy with esophagojejunal Roux-en-Y limb reconstruction.…”

Section: Key Pointsmentioning

confidence: 99%

Total Gastrectomy with Roux-en-Y Limb Reconstruction for Complex and Chronic Fistulas After Laparoscopic Sleeve Gastrectomy: Single-Center Experience

Montana

Frosio

Polliand³

et al. 2021

OBES SURG

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Purpose When a leak after laparoscopic sleeve gastrectomy (LSG) becomes a chronic fistula, the best surgical treatment remains controversial. The aim of study was to review our experience concerning the treatment of chronic and complex fistulas after LSG. Materials and Methods A retrospective analysis of patients with a gastric fistula following LSG who were treated at our center between January 2013 and December 2018 was performed. All patients included underwent a total gastrectomy with a Roux-en-Y reconstruction (TG) for LSG chronic fistula. Results During the period considered, 13 patients had a chronic fistula and were treated with open TG. The primary leak evolved to a gastro-cutaneos fistula in three patients (23%), to a gastro-splenic fistula in two patients (15.4%), to a gastropleural fistula in four patients (30.8%), and to a gastro-bronchial fistula in four patients (30.8%). During TG, a splenectomy and a spleno-pancreatectomy were needed in the two cases of gastro-splenic fistula. Five patients (38.5%) developed an early complication. Two patients developed an esophago-jejunal anastomotic leak treated with a conservative approach (15.4%). No patients needed hospitalization in the intensive care unit. Overall mean length of stay was 19 days (8-30 days). Mean BMI before LSG was 36 (± 5 kg/m 2 ), mean BMI before TG was 30.3 (± 5.2 kg/m 2 ), and mean BMI 2 years after TG was 23.5 (± 2.9 kg/m 2 ). Conclusion When a more conservative and less mutilating surgical option is not possible, open TG with esophago-jejunostomy remains a valuable salvage procedure in the case of complex and extensive fistulas after LSG.

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“…They stated that salvage open total gastrectomy with an esophagojejunostomy is a well-tolerated and reproducible salvage procedure for cases of a Post Sleeve Gastrectomy Chronic Fistula, when conservative procedures are not possible. 17 Early re-suturing within the first three days can bring about fruitful results versus re-suturing of breaks after the third day according to studies by Praveenraj and colleagues in 2016. 18 Seven patients in our study seen by early careful follow up, were treated by direct suturing of leak site with effective leak control.…”

Section: Long-term No (%)mentioning

confidence: 99%

Comparative Study between Surgical Intervention and Endoscopic Stenting for Management of Leakage after Sleeve Gastrectomy

Aziz

Mahmoud

2020

Ain Shams Journal of Surgery

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Objectives: To evaluate surgical intervention versus stents insertion in management of staple line leaks after laparoscopic sleeve gastrectomy in morbidly obese patients.Patients and methods: Prospective randomized study including 30 hemodynamically stable patients presented early post sleeve leaks discovered by routine postoperative imaging or during follow up period. Patients recruited from El-Demerdash university hospital and El Zahraa university hospital during period January 2014 to December 2018. Patients were divided in two equal ratio groups: Endoscopy group: included 15 patients post sleeve leakage underwent stent insertion and Surgery group: included 15 patients post sleeve leakage underwent surgical management.Results: Mean interval between Initial surgery and leak in endoscopy group was 4.5±2.7 days with most common site of leak GE junction (80%). Mean interval between Initial surgery and leak in surgery group was 4.6±2.2 days; while most common site leak, GE junction (73.3%) with no statistical significance. Leak closure was achieved in 13 (86.66%) in endoscopy group and only 2 patients required conversion R en Y with closure of leak and leak control within 3.3±5.5 days. Average hospital stay was 8.3 ±4.4 days. Leak closure achieved in 7 (46.6%) 13 (86.66%) in surgery group, seven patients required conversion to R en Y either from the start or after failure of direct suturing to control spillage, while one patients died. interval between closure of leak and leak control was 5 ±4.3 days. With average hospital stay 8.3 ±4.4 days. There was no statistically significant association between type of management and outcomes (p =0.51). In contrary, there was statistically significant association between type of management and interval for leak control (p <0.001) and hospital stay (p=0.012). There was no statistically significant association between the site of leak in both groups (p=0.48). Conclusion:Stenting is a better choice for spillage patients who are essentially steady. It is less dangerous than surgical procedure.

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

Cited by 27 publications

References 25 publications

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Revisional Surgeries of Laparoscopic Sleeve Gastrectomy

Total Gastrectomy with Roux-en-Y Limb Reconstruction for Complex and Chronic Fistulas After Laparoscopic Sleeve Gastrectomy: Single-Center Experience

Comparative Study between Surgical Intervention and Endoscopic Stenting for Management of Leakage after Sleeve Gastrectomy

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