Postoperative gastric fistula

Endoscopic esophageal self-expanding stent implantation WallFlex™ (boston scientific) in the management of a gastrocutaneous fistula, as a complication of sleeve bariatric gastrectomy

“…Improper selection of the size of the staples and suture line, are also responsible for possible leakage. Other coexisting causes include acute or chronic inflammation, abscess in the left upper abdominal quadrant or epigastrium, gastric irritation by a foreign body (drains), splenectomy, as well as complications after long-lasting gastrostomy (6,9). At this point one should pay special attention to the multifactorial character of the described complication, in which concomitant diseases play a significant role, often present in obese patients, which negatively influence the general anastomotic healing process and might lead to the development of gastric wall necrosis (3,7).…”

“…The most common clinical symptoms of GCF include gastric content leakage through the external ostium with irritation of surrounding skin, nausea, vomiting, infiltration of the lower pulmonary lungs, and pleural effusion. The most sensitive symptom is intractable tachycardia (>100/min) of unknown cause, fever, and left upper quadrant abdominal pain radiating to the left scapula (1,4,5,9). In case of each patient after bariatric surgery of the stomach presenting with the above-mentioned symptoms, X-ray contrast enema and abdominal CT should be performed (4,5,9).…”

“…The most sensitive symptom is intractable tachycardia (>100/min) of unknown cause, fever, and left upper quadrant abdominal pain radiating to the left scapula (1,4,5,9). In case of each patient after bariatric surgery of the stomach presenting with the above-mentioned symptoms, X-ray contrast enema and abdominal CT should be performed (4,5,9). One should not forget that CT does not exclude the above-mentioned condition, and can only confirm its presence (1).…”

“…In cases when the patient is hemodynamically stable and presents mild symptoms, conservative therapy is the treatment of choice, while open surgery should be reserved in life-threatening conditions or in case of failure, considering current therapy (4,5). Initial management comprises the following: gastrointestinal decompression by means of a probe, which allows fluid parenteral nutrition, distally to the fistula, external active drainage, water-electrolyte supplementation, and antibiotics therapy (2,6,7,9). The most significant factor considering conservative treatment consists in the combination of total parenteral nutrition, somatostatin or its analogue-octreotide, and PPIs.…”

“…The most significant factor considering conservative treatment consists in the combination of total parenteral nutrition, somatostatin or its analogue-octreotide, and PPIs. A recognized adjuvant method consists in numerous endoscopic procedures with the use of tissue glues, OTSC clip systems, SurgSIS, and most frequently used self-expanding esophageal stents (partially or completely covered) (1,5,9,10). The implantation of a covered stent into the gastric tube leads to immediate closure of the internal ostium, is an additional barrier protecting against inflammation, and allows the implementation of early oral nutrition.…”