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Management of Type 1 Late Sleeve Leak with Gastrobronchial Fistula by Laparoscopic Suturing and Conversion to Roux-en-Y Gastric Bypass: Video Report

Abstract

Background

Gastrobronchial fistula (GBF) is a rare but serious complication after laparoscopic sleeve gastrectomy (LSG). It commonly appears sometime after the primary LSG. (Alharbi Ann Thorac Med. 8(3):179–80, 2013; Albanopoulos et al. Surg Obes Relat Dis. 9(6):e97–9, 2013). Surgical approach is an effective treatment. (Rebibo et al. Surg Obes Relat Dis. 10(3):460–67, 2014).

The aim of this video was to demonstrate the operative management of a gastrobronchial fistula after LSG by laparoscopic suturing and conversion to a Roux-en-Y gastric bypass (RYGB).

Methods

We present the case of a 53-year-old woman, with a BMI of 50.2 who presented with a left lower lobe consolidation 7 months after LSG. Imaging revealed a gastrobronchial fistula with left lower lobe consolidation and small sub-diaphragmatic collections. Endoscopy done revealed a fistulous opening beyond the oesophago-gastric junction and a trial of endoscopic stenting failed.

Results

In this multimedia high definition video, we present step-by-step the operative management of a late sleeve leak with gastrobronchial fistula by laparoscopic suturing and conversion to a RYGB. The procedure included mobilization of the gastric sleeve, identification and suturing of the fistulous opening, creation of a gastric pouch, creation of an ante-colic Roux limb, gastro-jejunal anastomosis and jejuno-jejunal anastomosis. Drainage of the fistula decreased with absence of a leak on imaging and pneumonia resolved in 15 days. This patient was diagnosed 7 months postoperatively with a gastric sleeve leak and the time to fistula closure from diagnosis was 2 months.

Conclusion

GBF is a severe complication of bariatric surgery that usually presents late in the postoperative period. GBF after LSG can be treated by surgical fistula repair and conversion of the sleeve into a RYGB.

References

  1. 1.

    Alharbi SR. Gastrobronchial fistula a rare complication post laparoscopic sleeve gastrectomy. Ann Thoracic Medicine. 2013;8(3):179–80.

  2. 2.

    Albanopoulos K, Tsamis D, Leandros E. Gastrobronchial fistula as a late complication of sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):e97–9.

  3. 3.

    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.

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Author information

Correspondence to Palanivelu Praveenraj.

Ethics declarations

Informed consent was obtained from all individual participants included in the study. The study has been approved by the appropriate institutional committee.

Financial Support

None.

Conflicts of Interest

The authors declare that they have no competing interests.

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Praveenraj, P., Gomes, R.M., Kumar, S. et al. Management of Type 1 Late Sleeve Leak with Gastrobronchial Fistula by Laparoscopic Suturing and Conversion to Roux-en-Y Gastric Bypass: Video Report. OBES SURG 25, 2462 (2015) doi:10.1007/s11695-015-1912-3

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Keywords

  • Bariatric surgery
  • Gastric sleeve leak
  • Morbid obesity
  • Sleeve gastrectomy
  • Gastrobronchial fistula