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Roux-En-Y Fistulo-Jejunostomy as a salvage procedure in patients with post–sleeve gastrectomy fistula

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Abstract

Background

Sleeve gastrectomy (SG) is currently the most common bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction of comorbidities. However, leak is still the most common complication after SG. Nevertheless, its risk of occurrence is <3 % in specialized centers. Its management is difficult, long, and challenging. Although the procedure is commonly endoscopic and nonoperative, the management of post-SG fistulas could sometimes be surgical, including peritoneal lavage, abscess drainage, disrupted staple line suturing, resleeve, gastric bypass, or total gastrectomy. Roux-en-Y fistulojejunostomy (RYFJ) has been described as a salvage option. In this study, we report the early results of RYFJ for post-SG fistula, emphasizing indications, operative technique, and short-term outcome.

Methods

Between January 2007 and December 2012, we treated 62 patients with post-SG fistula. Before surgery, intra-abdominal or thoracic abscesses or collections were either excluded or treated by computed tomographic scan–guided drainage or even surgery. Endoscopic stenting was then attempted. After optimization of the nutritional status in case of failure of endoscopic measures, some of the patients underwent RYFJ.

Results

Between January 2007 and December 2012, a total of 21 patients (16 women and 5 men) had RYFJ for post-SG fistula. Mean age was 47 years (range, 22–59 years). Procedures were performed laparoscopically in all but 3 cases. The rate of secondary conversion to laparotomy was 11.1 %. The was no mortality. The postoperative morbidity rate was less than 5 %. The rate of fistula control was eventually 100 %.

Conclusions

RYFJ is a safe and feasible salvage procedure for the treatment of patients with post-SG fistula. Longer outcome analysis is, however, needed especially regarding the physiological and metabolic behavior of the procedure.

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Disclosures

Elie Chouillard, Elias Chahine, Naim Schoucair, Antoine Younan, Mohammad Al Jarallah, Alain Fajardy, René-Louis Vitte, and Jean Biagini have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Bariatric Surgery, Department of Surgery, Poissy/Saint-Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France

    Elie Chouillard, Elias Chahine & Naim Schoucair

  2. Department of General Surgery, Lebanese-Canadian Hospital, Beirut, Lebanon

    Antoine Younan

  3. Department of Bariatric Surgery, Al-Jarrallah German Specialized Center, Kuwait City, Kuwait

    Mohammad Al Jarallah

  4. Department of Surgery, Unit of Critical Care and Nutrition, Poissy/Saint-Germain Medical Center, Poissy, France

    Alain Fajardy

  5. Division of Surgical Endoscopy, Department of Gastroenteroplogy and Hepatology, Poissy/Saint-Germain Medical Center, Poissy, France

    René-Louis Vitte

  6. Department of General and Digestive Surgery, Saint-Joseph Medical Center, Beirut, Lebanon

    Jean Biagini

Authors
  1. Elie Chouillard
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  2. Elias Chahine
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  4. Antoine Younan
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  5. Mohammad Al Jarallah
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  6. Alain Fajardy
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  7. René-Louis Vitte
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  8. Jean Biagini
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Corresponding author

Correspondence to Elie Chouillard.

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On behalf of the Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), France

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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 28, 1954–1960 (2014). https://doi.org/10.1007/s00464-014-3424-y

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  • DOI: https://doi.org/10.1007/s00464-014-3424-y

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