Abstract
Background
Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713–723. doi:10.1016/j.soard.2014.01.016, 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954–1960 doi:10.1007/s00464-014-3424-y, 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome.
Methods
Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series.
Results
Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22–59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18–90). Mean body mass index (BMI) was 27.4 kg/m2 (22–41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections.
Conclusions
Despite the lack of long-term follow-up, RYFJ could be a safe and feasible salvage option for the treatment of patients with post-SG fistula, especially those who failed conservative management. Mid-term outcome analysis confirms that fistula control is durable. Weight loss panel is satisfactory.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gagner M, Buchwald JN (2014) Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review. Surg Obes Relat Dis 10:713–723. doi:10.1016/j.soard.2014.01.016
Chouillard E, Chahine E, Schoucair N, Younan A, Jarallah MA, Fajardy A, Vitte RL, Biagini J (2014) Roux-En-Y Fistulo-Jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula. Surg Endosc 28:1954–1960. doi:10.1007/s00464-014-3424-y
Wölnerhanssen B, Peterli R (2014) State of the art: sleeve gastrectomy. Dig Surg 31:40–47. doi:10.1159/000354320
Gagner M (2015) Effect of sleeve gastrectomy on type 2 diabetes as an alternative to Roux-en-Y gastric bypass: a better long-term strategy. Surg Obes Relat Dis S1550–7289(15):00064–00067. doi:10.1016/j.soard.2015.03.009
Aurora AR, Khaitan L, Saber AA (2012) Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc 26:1509–1515. doi:10.1007/s00464-011-2085-3
Burgos AM, Braghetto I, Csendes A, Maluenda F, Korn O, Yarmuch J, Gutierrez L (2009) Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg 19:1672–1677. doi:10.1007/s11695-009-9884-9
Serra C, Baltasar A, Andreo L, Perez N, Bou R, Bengochea M, Chisbert JJ (2007) Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg 17:866–872
Tan JT, Kariyawasam S, Wijeratne T, Chandraratna HS (2010) Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20:403–409
Donatelli G, Dumont JL, Cereatti F, Ferretti S, Vergeau BM, Tuszynski T, Pourcher G, Tranchart H, Mariani P, Meduri A, Catheline JM, Dagher I, Fiocca F, Marmuse JP, Meduri B (2015) Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 25:1293–1301. doi:10.1007/s11695-015-1675-x
Sakran N, Goitein D, Raziel A, Keidar A, Beglaibter N, Grinbaum R, Matter I, Alfici R, Mahajna A, Waksman I, Shimonov M, Assalia A (2013) Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc 27:240–245. doi:10.1007/s00464-012-2426-x
Alazmi W, Al-Sabah S, Ali DA, Almazeedi S (2014) Treating sleeve gastrectomy leak with endoscopic stenting: the Kuwaiti experience and review of recent literature. Surg Endosc 28:3425–3428. doi:10.1007/s00464-014-3616-5
Walsh C, Karmali S (2015) Endoscopic management of bariatric complications: a review and update. World J Gastrointest Endosc 7:518–523. doi:10.4253/wjge.v7.i5.518
Baltasar A, Bou R, Bengochea M, Serra C, Cipagauta L (2007) Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg 17:1408–1410
Baltasar A, Serra C, Bengochea M, Bou R, Andreo L (2008) Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis 4:759–763
Yehoshua RT, Eidelman LA, Stein M, Fichman S, Mazor A, Chen J, Bernstine H, Singer P, Dickman R, Beglaibter N, Shikora SA, Rosenthal RJ, Rubin M (2008) Laparoscopic sleeve gastrectomy–volume and pressure assessment. Obes Surg 18:1083–1088. doi:10.1007/s11695-008-9576-x
Casella G, Soricelli E, Rizzello M, Trentino P, Fiocca F, Fantini A, Salvatori FM, Basso N (2009) Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg 19:821–826. doi:10.1007/s11695-009-9840-8
Gagner M, Deitel M, Erickson AL, Crosby RD (2013) Survey on laparoscopic sleeve gastrectomy (LSG) at the fourth international consensus summit on sleeve gastrectomy. Obes Surg 23:2013–2017. doi:10.1007/s11695-013-1040-x
Masuzawa T, Takiguchi S, Hirao M, Imamura H, Kimura Y, Fujita J, Miyashiro I, Tamura S, Hiratsuka M, Kobayashi K, Fujiwara Y, Mori M, Doki Y (2014) Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg 38:1100–1106. doi:10.1007/s00268-013-2370-5
Chouillard EK, Karaa A, Elkhoury M, Greco VJ, Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (iNOELS) (2011) Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity: case-control study. Surg Obes Relat Dis 7:500–505. doi:10.1016/j.soard.2011.01.037
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Drs. Elie Chouillard, Bernard Dejonghe, Mubarak Alkandari, Ronald Daher, Antoine Younan, Salman Alsabah, and Jean Biagini have no conflicts of interest or financial ties to disclose.
Additional information
On behalf of The Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), France.
An erratum to this article can be found at http://dx.doi.org/10.1007/s00464-016-5102-8.
Rights and permissions
About this article
Cite this article
Chouillard, E., Younan, A., Alkandari, M. et al. Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results. Surg Endosc 30, 4200–4204 (2016). https://doi.org/10.1007/s00464-015-4700-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-015-4700-1