Skip to main content
SpringerLink
Log in

Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG.

Methods

Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed.

Results

Seventeen patients (13 women) with a median age of 39 years (24–67) with a median body mass index (BMI) of 40 kg/m2 (30–52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2–49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded.

Conclusions

Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lazzati A, Guy-Lachuer R, Delaunay V, et al. Bariatric surgery trends in France: 2005–2011. Surg Obes Relat Dis. 2014;10(2):328–34.

    Article  Google Scholar 

  2. Ponce J, Nguyen NT, Hutter M, et al. American Society for Metabolic and Bariatric Surgery estimation of bariatric surgery procedures in the United States, 2011-2014. Surg Obes Relat Dis. 2015;11(6):1199–200.

    Article  Google Scholar 

  3. Smith ZL, Park KH, Llano EM, et al. Outcomes of endoscopic treatment of leaks and fistulae after sleeve gastrectomy: results from a large multicenter U.S. cohort. Surg Obes Relat Dis. 2019;15(6):850–5.

    Article  Google Scholar 

  4. Frattini F, Delpini R, Inversini D, et al. Gastric leaks after sleeve gastrectomy: focus on pathogenetic factors. Surg Technol Int. 2017;31:123–6.

    PubMed  Google Scholar 

  5. Noel P, Nedelcu M, Gagner M. Impact of the surgical experience on leak rate after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(8):1782–7.

    Article  Google Scholar 

  6. Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20(4):403–9.

    Article  Google Scholar 

  7. Nedelcu M, Manos T, Cotirlet A, et al. Outcome of leaks after sleeve gastrectomy based on a new algorithm adressing leak size and gastric stenosis. Obes Surg. 2015;25(3):559–63.

    Article  Google Scholar 

  8. Mahadev S, Kumbhari V, Campos JM, et al. Endoscopic septotomy: an effective approach for internal drainage of sleeve gastrectomy-associated collections. Endoscopy. 2017;49(5):504–8.

    Article  Google Scholar 

  9. Nedelcu AM, Skalli M, Deneve E, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):879–84.

    Article  Google Scholar 

  10. Safadi BY, Shamseddine G, Elias E, et al. Definitive surgical management of staple line leak after sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(5):1037–43.

    Article  Google Scholar 

  11. van de Vrande S, Himpens J, El Mourad H, et al. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis. 2013;9(6):856–61.

    Article  Google Scholar 

  12. Ramos AC, Ramos MG, Campos JM, et al. Laparoscopic total gastrectomy as an alternative treatment to post- sleeve chronic fistula. Surg Obes Relat Dis. 2015;11(3):552–6.

    Article  Google Scholar 

  13. Blot C, Mouly C, Rebibo L, et al. Conservative surgical management of persistent leak after sleeve gastrectomy by Roux-en-Y gastro-jejunostomy to the fistulous orifice. J Visc Surg. 2015;152(1):39–44.

    Article  CAS  Google Scholar 

  14. Sakran N, Assalia A, Keidar A, et al. Gastrobronchial fistula as a complication of bariatric surgery: a series of 6 cases. Obes Facts. 2012;5(4):538–45.

    Article  Google Scholar 

  15. Guillaud A, Moszkowicz D, Nedelcu M, et al. Gastrobronchial fistula: a serious complication of sleeve gastrectomy. Results of a French multicentric study. Obes Surg. 2015;25(12):2352–9.

    Article  Google Scholar 

  16. Takahashi H, Strong AT, Guerron AD, et al. An odyssey of complications from band, to sleeve, to bypass; definitive laparoscopic completion gastrectomy with distal esophagectomy and esophagojejunostomy for persistent leak. Surg Endosc. 2018;32(1):507–10.

    Article  Google Scholar 

  17. Ben Yaacov A, Sadot E, Ben David M, et al. Lapa- roscopic total gastrectomy with Roux-y esophagojejunostomy for chronic gastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):425–9.

    Article  Google Scholar 

  18. Chouillard E, Chahine E, Schoucair N, et al. Roux-En-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula. Surg Endosc. 2014;28(6):1954–60.

    Article  Google Scholar 

  19. Mahmoud M, Maasher A, Al Hadad M, et al. Laparoscopic Roux en Y esophago-jejunostomy for chronic leak/fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2016;26(3):679–82.

    Article  Google Scholar 

  20. Bruzzi M, Douard R, Voron T, et al. Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(10):1803–8.

    Article  Google Scholar 

  21. Moon RC, Shah N, Teixeira AF, et al. Management of staple line leaks following sleeve gastrectomy. Surg Obes Relat Dis. 2015;11(1):54–9.

    Article  Google Scholar 

  22. Rebibo L, Dhahri A, Berna P, et al. Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(3):460–7.

    Article  Google Scholar 

  23. Chour M, Alami RS, Sleilaty F, et al. The early use of Roux limb as surgical treatment for proximal postsleeve gastrectomy leaks. Surg Obes Relat Dis. 2014;10(1):106–10.

    Article  Google Scholar 

  24. Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Oeso-gastric Surgery Unit, Magellan University Hospital, Bordeaux, France

    Olivier Degrandi, Agathe Simon, Denis Collet & Caroline Gronnier

  2. Bordeaux Medicine University, Bordeaux, France

    Olivier Degrandi, Agathe Simon, Denis Collet & Caroline Gronnier

  3. Clinique Saint Michel, ELSAN, Toulon, France

    Anamaria Nedelcu & Marius Nedelcu

  4. Clinique Bouchard, ELSAN, Marseille, France

    Marius Nedelcu

  5. Oeso-gastric Surgery Unit, Magellan University Hospital, Avenue de Magellan, 33600, Pessac, France

    Denis Collet

Authors
  1. Olivier Degrandi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anamaria Nedelcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marius Nedelcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Agathe Simon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Denis Collet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Caroline Gronnier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Denis Collet.

Ethics declarations

Conflict of Interest

Authors O. Degrandi, A. Nedelcu, A. Simon, M. Nedelcu, D. Collet, and C. Gronnier have no conflicts of interest or financial ties to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Degrandi, O., Nedelcu, A., Nedelcu, M. et al. Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy. OBES SURG 31, 79–83 (2021). https://doi.org/10.1007/s11695-020-04646-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04646-6

Keywords

Search

Navigation