Advertisement

Obesity Surgery

, Volume 29, Issue 2, pp 749–750 | Cite as

Laparoscopic Roux-En-Y Fistulo-Jejunostomy, a Preferred Technique after Failure of Endoscopic and Radiologic Management of Fistula Post Sleeve Gastrectomy

  • Imed Ben Amor
  • Tarek DebsEmail author
  • Giorgio Dalmonte
  • Radwan Kassir
  • Patrick Baqué
  • Niccolo Petrucciani
  • Jean Gugenheim
Video Submission
  • 54 Downloads

Abstract

Background

Laparoscopic sleeve gastrectomy represents the most performed bariatric procedure in France. Staple line leak is the major short-term complication of the procedure. Patients with persistent fistula after sleeve gastrectomy, after failure of endoscopic and radiological treatment, are candidates for salvage surgery. Laparoscopic fistulo-jejunostomy (LRYFJ) represents a surgical option to treat persistent fistula post sleeve.

Methods

The case of a 46-year-old woman, with persistent fistula after sleeve gastrectomy, undergoing laparoscopic fistula-jejunostomy is presented. The patient developed an abdominal abscess 2 months after sleeve gastrectomy, treated with radiological drainage. Upper gastrointestinal endoscopy was performed for pigtail insertion. Three months later, the fistula was persistent and salvage surgery was proposed. At surgery, the pigtail drain and the fistula orifice were identified with careful dissection. Then a manual Roux-en-Y fistula-jejunal anastomosis and a mechanical jejuno-jejunal anastomosis are performed.

Results

The postoperative course was uneventful.

Conclusions

LRYFJ for chronic fistula after sleeve gastrectomy is safe and effective. However, it remains a challenging procedure and should be reserved for specialized centers.

Keywords

Surgical technique Roux-En-Y fistulo-jejunostomy Sleeve gastrectomy Fistulas post sleeve 

Notes

Compliance with Ethical Standards

Declaration of Interest

The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from the participant.

Statement of Human Rights

Informed consent was obtained from the participant.

Supplementary material

ESM 1

(MP4 370486 kb)

References

  1. 1.
    Debs T, Petrucciani N, Kassir R, et al. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005-2014. Surg Obes Relat Dis. 2016;12:1602–9.CrossRefGoogle Scholar
  2. 2.
    Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg. 2015;25:1133–41.CrossRefGoogle Scholar
  3. 3.
    Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17:866–72.CrossRefGoogle Scholar
  4. 4.
    Baltasar A, Bou R, Bengochea M, et al. Use of a roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17:1408–10.CrossRefGoogle Scholar
  5. 5.
    Baltasar A, Serra C, Bengochea M, et al. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4:759–63.CrossRefGoogle Scholar
  6. 6.
    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.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Digestive Surgery, Archet II HospitalUniversity of Nice-Sophia-AntipolisNiceFrance
  2. 2.Unit of Clinical Surgery, Department of Medicine and SurgeryParma University HospitalParmaItaly
  3. 3.Department of Bariatric SurgeryCHU Félix GuyonSaint-DenisFrance
  4. 4.Division of Digestive SurgeryHenri Mondor University Hospital, UPECCreteilFrance

Personalised recommendations