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Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options

Abstract

This study aimed to establish the optimal diagnostic and treatment algorithm for the management of gastric fistula in the chest (GFIC) after sleeve gastrectomy (SG) through a systematic review of published cases. A multi-database search was performed, which produced 1182 results, of which 26 studies were included in this systematic review. The initial presentation included subphrenic collections, leaks, or (recurrent) pneumonia with associated symptoms such as persistent cough, fever, and/or dyspnea. Computed tomography (CT) scan in combination with either upper gastrointestinal (UGI) series or an esophagogastroduodenoscopy (EGD) was used to adequately diagnose the fistulas. Initial treatment was either with clips and/or clips and stents that were placed endoscopically. When unsuccessful in the majority of the cases, the surgical treatment consisted of total gastrectomy and Roux-en-Y esophagojejunostomy in a laparoscopic or open fashion.

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Contributions

Initial idea: NS

Literature searches: NS and SP

Data analysis: NS, RZ, BM, YG, CP, KM, and SP

Writing the manuscript: NS, RZ, BM, YG, CP, KM, and SP

Final approval: NS, RZ, BM, YG, CP, KM, and SP

Corresponding author

Correspondence to Nasser Sakran.

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This systematic review is part of a bigger project in the Global Bariatric Research Collaborative

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Sakran, N., Zakeri, R., Madhok, B. et al. Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options. OBES SURG 31, 357–369 (2021). https://doi.org/10.1007/s11695-020-05078-y

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  • DOI: https://doi.org/10.1007/s11695-020-05078-y

Keywords

  • Bariatric surgery
  • Gastro-bronchial fistula
  • Gastro-pleural fistula
  • Gastro-pulmonary fistula
  • Sleeve gastrectomy