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.
Similar content being viewed by others
References
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.
Rosenthal RJ, Diaz AA, Arvidsson D, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.
Iannelli A, Treacy P, Sebastianelli L, et al. Perioperative complications of sleeve gastrectomy: review of the literature. J Minim Access Surg. 2019;15(1):1–7.
Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904–10.
Praveenraj P, Gomes RM, Kumar S, et al. Management of type 2 late sleeve leak by laparoscopic suturing and conversion to Roux-en-Y gastric bypass: video report. Obes Surg. 2015;25(10):1984.
Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19(12):1672–7.
Marie L, Robert M, Montana L, et al. A French national study on gastropleural and gastrobronchial fistulas after bariatric surgery: the impact of therapeutic strategy on healing. Obes Surg. 2020;30:3111–8.
Sakran N, Assalia A, Keidar A, et al. Gastrobronchial fistula as a complication of bariatric surgery: a series of 6 cases. Obes Facts. 2012;5(4):538–45.
Ben Nun A, Simansky D, Rokah M, et al. Surgical treatment of gastro-pulmonary fistula following bariatric surgery: possible and safe. World J Surg. 2018;42(6):1792–7.
Guillaud A, Moszkowicz D, Nedelcu M, et al. Gastrobronchial fistula: a serious complication of sleeve gastrectomy. Results of a French multicentric study. Obes Surg. 2015;25(12):2352–9.
Altman D. Practical statistics for medical research. London: Chapman and Hal; 1991.
El Dib R, Nascimento Junior P, Kapoor A. An alternative approach to deal with the absence of clinical trials: a proportional meta-analysis of case series studies. Acta Cir Bras. 2013;28(12):870–6.
Rebibo L, Bartoli E, Dhahri A, et al. Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation. Surg Obes Relat Dis. 2016;12(1):84–93.
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.
Albanopoulos K, Tsamis D, Leandros E. Gastrobronchial fistula as a late complication of sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):e97–9.
Alharbi A, Alnaami M, Alsayyari A, et al. Mini gastric bypass for the management of gastrobronchial fistula: a case report. Int J Surg Case Rep. 2020;66:192–5.
Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.
Guerrero-Silva LA, Lopez-Garcia S, Guardado-Bermudez F, et al. Gastro-bronchial fistula major complication of sleeve gastrectomy. Cir Cir. 2015;83(1):46–50.
Alkhatib SG, Levine MS. Gastrobronchial fistula after sleeve gastrectomy: clinical and radiographic findings. Clin Imaging. 2019;53:112–4.
Meunier H, Menahem B, Mulliri A, et al. Esophagopericardial fistula: an unexpected dreaded complication of treatment of leak following revisional sleeve gastrectomy by endoscopic internal drainage. J Surg Case Rep. 2017;2017(3):rjx049.
Alshammari A, Alam SF, Ahmed MH, et al. A thoracoabdominal approach for gastrobronchial fistula repair post complicated laparoscopic sleeve gastrectomy. Int J Surg Case Rep. 2018;45:112–5.
Ciochina M, Cruceru M, Rivory J, et al. Esophagobronchial fistula after sleeve gastrectomy successfully treated by endoscopic submucosal dissection and over-the-scope clip. Endoscopy. 2020;52(3):E100–E1.
Saliba C, Nicolas G, Diab S, et al. Gastrobronchial fistula following a laparoscopic sleeve gastrectomy. Am J Case Rep. 2019;20:31–5.
Baltasar A, Serra C, Bengochea M, et al. Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas. Surg Obes Relat Dis. 2008;4(6):759–63.
Bruzzi M, M’Harzi L, Poghosyan T, et al. Anatomical relations between the esogastric junction, the diaphragm, the pleura, and the left lung in chronic esogastro-bronchial and/or esogastro-pleural fistulas after sleeve gastrectomy. Obes Surg. 2019;29(9):2814–23.
Boru CE, Angelis F, Iossa A, et al. Persistent fistula after sleeve gastrectomy: a chronic dilemma. Chirurgia (Bucharest, Romania : 1990). 2019;114(6):790–7.
Al-Lehibi A. Endoscopic management of gastrobronchial fistula after laparoscopic sleeve gastrectomy: a case report. Saudi J Med Med Sci. 2019;7(2):106–9.
Praveenraj P, Gomes RM, 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. 2015;25(12):2462.
Tabbara M, Polliand C, Barrat C. Gastrobronchial fistula: a rare complication of sleeve gastrectomy. J Visc Surg. 2015;152(6):395–6.
Fuks D, Dumont F, Berna P, et al. Case report-complex management of a postoperative bronchogastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(2):261–4.
Abraham A, Virdi RP, Rajan D, et al. Gastrobronchial fistula following laparoscopic sleeve gastrectomy. BMJ Case Rep. 2012;2012:bcr2012006789.
Sinna R, De Dominicis F, Quassemyar Q, et al. Diaphragmatic reconstruction using combined reversed extended latissimus dorsi and serratus anterior fascia flaps. Ann Thorac Surg. 2011;91(3):922–4.
Alghanim F, Alkhaibary A, Alzakari A, AlRumaih A. Gastropleural fistula as a rare complication of gastric sleeve surgery: a case report and comprehensive literature review. Case Rep Surg. 2018;1–5.
Cimpean S, Marechal MT, Cadiere B, et al. Re-sleeve gastrectomy for chronic leak with gastro-pleural fistula post-sleeve gastrectomy. EC Gastroenterol Dig Syst. 2019;6(6):481–5.
Al Bogami OH, Al-Zahrani AS, Ali BI. Gastrobronchial fistula post laparoscopic sleeve gastrectomy in immunocompromised patient. Int Surg J. 2019;6(12):4530–4.
Maghrabi AA, Aldagal S, Sultan A, et al. Bronchoesophageal fistula, a rare complication post laparoscopic sleeve gastrectomy; a case report and literature review. Saudi Surg J. 2019;7(4):167–71.
Iannelli A, Tavana R, Martini F, et al. Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(5):825–8.
Serra C, Baltasar A, Andreo L, et al. Treatment of gastric leaks with coated self-expanding stents after sleeve gastrectomy. Obes Surg. 2007;17(7):866–72.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical research ed). 2009;339:b2700.
Marquez MF, Ayza MF, Lozano RB, et al. Gastric leak after laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(9):1306–11.
Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, October 25-27, 2007. Obes Surg. 2008;18(5):487–96.
Batchelder AJ, Williams R, Sutton C, et al. The evolution of minimally invasive bariatric surgery. J Surg Res. 2013;183(2):559–66.
Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231–7.
Markowitz AM, Herter FP. Gastro-pleural fistula as a complication of esophageal hiatal hernia. Ann Surg. 1960;152(1):129–34.
Moeller DD, Carpenter PR. Gastrobronchial fistula: case report and review of the English literature. Am J Gastroenterol. 1985;80(7):538–41.
Campos JM, Siqueira LT, Ferraz AA, et al. Gastrobronchial fistula after obesity surgery. J Am Coll Surg. 2007;204(4):711.
Nedelcu AM, Skalli M, Deneve E, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):879–84.
Skalli EM, Parmar CD. Necrosis of the Nissen-sleeve Gastrectomy (N-SG) wrap. Obes Surg. 2020;30(10):4174–5.
Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.
van de Vrande S, Himpens J, El Mourad H, et al. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic Roux-limb placement. Surg Obes Relat Dis. 2013;9(6):856–61.
Giuliani A, Romano L, Marchese M, et al. Gastric leak after laparoscopic sleeve gastrectomy: management with endoscopic double pigtail drainage. A systematic review. Surg Obes Relat Dis. 2019;15(8):1414–9.
Giuliani A, Romano L, Papale E, et al. Complications of postlaparoscopic sleeve gastric resection: review of surgical technique. Minerva Chir. 2019;74(3):213–7.
Serra C, Baltasar A, Pérez N, et al. Total gastrectomy for complications of the duodenal switch, with reversal. Obes Surg. 2006;16(8):1082–6.
Author information
Authors and Affiliations
Consortia
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
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Statement of Human and Animal Rights
Not applicable.
Statement of Informed Consent
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This systematic review is part of a bigger project in the Global Bariatric Research Collaborative
Rights and permissions
About this article
Cite this article
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
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-020-05078-y