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Laparoscopic Roux-en-Y Double Fistulo-Jejunostomy for Chronic Gastric Leaks After Converted Vertical Banded Gastroplasty to Sleeve Gastrectomy

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Abstract

Background

As laparoscopic sleeve gastrectomy (LSG) is becoming the most popular bariatric procedure worldwide, treatment options for managing complications, in particular gastric leaks, are also emerging. Staple line leak is a major short-term complication of the procedure. Patients with persistent gastric leaks after failure of endoscopic and radiologic management are candidates for salvage surgery. Laparoscopic Roux-en-Y fistulo-jejunostomy (RYFJ) represents a surgical option to treat persistent gastric leak post-LSG.

Methods

We present the case of a 55-year-old woman undergoing laparoscopic double RYFJ for persistent gastric leaks after complicated bariatric surgery. The patient developed two chronic gastric leaks (gastro-esophageal and cardial localizations) following conversion to sleeve gastrectomy for failed vertical banded gastroplasty. With the two leaks being refractory to endoscopic treatment 6 months later after laparoscopic sleeve gastrectomy, salvage surgery was proposed. Surgery was performed laparoscopically, the gastric leak orifices were identified after careful dissection, and a double RYFJ was successfully completed.

Results

Postoperative course was uneventful. The patient remains in good health 6 months after surgery.

Conclusions

Double LRYFJ for chronic leaks after complicated bariatric procedures seems safe with good postoperative outcomes. However, it remains a challenging procedure and should be reserved for selected patients in specialized bariatric centers.

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Authors and Affiliations

  1. Department of Digestive Surgery, Archet II Hospital, Nice, France

    Imed Ben Amor, Jean Hubert Etienne, Vincent Casanova & Jean Gugenheim

  2. University of Nice-Sophia-Antipolis, Nice, France

    Imed Ben Amor & Jean Gugenheim

  3. INSERM U1081, Nice, France

    Imed Ben Amor & Jean Gugenheim

  4. Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique – Hôpitaux de Paris, F-92140, Clamart, France

    Panagiotis Lainas, Radwan Kassir & Ibrahim Dagher

  5. Paris-Saclay University, F-91405, Orsay, France

    Panagiotis Lainas & Ibrahim Dagher

Authors
  1. Imed Ben Amor
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  2. Panagiotis Lainas
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  3. Radwan Kassir
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  4. Jean Hubert Etienne
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  5. Vincent Casanova
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  6. Ibrahim Dagher
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  7. Jean Gugenheim
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Corresponding author

Correspondence to Panagiotis Lainas.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Amor, I.B., Lainas, P., Kassir, R. et al. Laparoscopic Roux-en-Y Double Fistulo-Jejunostomy for Chronic Gastric Leaks After Converted Vertical Banded Gastroplasty to Sleeve Gastrectomy. OBES SURG 30, 378–380 (2020). https://doi.org/10.1007/s11695-019-04255-y

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  • DOI: https://doi.org/10.1007/s11695-019-04255-y

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