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.
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References
Alharbi SR. Gastrobronchial fistula a rare complication post laparoscopic sleeve gastrectomy. Ann Thoracic Medicine. 2013;8(3):179–80.
Albanopoulos K, Tsamis D, Leandros E. Gastrobronchial fistula as a late complication of sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):e97–9.
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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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). https://doi.org/10.1007/s11695-015-1912-3
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DOI: https://doi.org/10.1007/s11695-015-1912-3