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An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy

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Abstract

Background

Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication.

Patients and methods

The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded.

Results

Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 ± 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 ± 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 ± 55.8 days and 21.4 ± 10.0 days after eliminating the data of first case. The average fistula size was 12 ± 10 mm, the average endoscopic procedure duration was 40 ± 16 min, and the average number of endoscopic procedures required was 1.6 ± 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred.

Conclusions

EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding.

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Acknowledgements

We are grateful to Gang Yu, Yunsheng Cheng, Benli Jia, Wei Yang, and Changlin Chao at the Department of General and Bariatric Surgery, the Second Hospital of Anhui Medical University, for their help in this study.

Funding

None.

Author information

Author notes

  1. Haiming Fang, Tingting Yao and Yating Chen have equally contributed to this work.

Authors and Affiliations

  1. Department of Gastroenterology, the Second Hospital of Anhui Medical University, Hefei, Anhui, China

    Haiming Fang, Tingting Yao, Yating Chen, Yan Lu, Kangwei Xiong, Yuan Su, Yujue Zhang & Lijiu Zhang

  2. Center of Gut Microbiota, the Second Hospital of Anhui Medical University, Hefei, Anhui, China

    Haiming Fang, Tingting Yao, Yating Chen, Yan Lu, Kangwei Xiong, Yuan Su, Yujue Zhang & Lijiu Zhang

  3. Department of General and Bariatric Surgery, the Second Hospital of Anhui Medical University, Hefei, Anhui, China

    Yong Wang

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  1. Haiming Fang
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  4. Yan Lu
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Contributions

HF, TY, and YC involved in conception and design of the study, acquisition of data, analysis and interpretation of the data, drafting and revising of the article, and final approval. YL, KX, YS, and YZ participated in acquisition of the data, analysis and interpretation of the data, and final approval. YW and LZ took part in conception and design of the study, critical revision of the article for important intellectual content, and final approval. All the authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Yong Wang or Lijiu Zhang.

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Disclosures

HF, TY, YC, YL, KX, YS, YZ, YW, and LZ have no conflict of interest or financial ties to disclose.

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Fang, H., Yao, T., Chen, Y. et al. An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy. Surg Endosc 36, 6439–6445 (2022). https://doi.org/10.1007/s00464-021-08992-z

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  • DOI: https://doi.org/10.1007/s00464-021-08992-z

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