Skip to main content
SpringerLink
Log in

Gastrobronchial Fistula: A Serious Complication of Sleeve Gastrectomy. Results of a French Multicentric Study

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Gastrobronchial fistula (GBF) is a complication of esophageal, splenic, or antireflux surgeries and was recently described as a complication of bariatric surgery. Our aim was to study all cases of GBF after laparoscopic sleeve gastrectomy (LSG) managed in five French university bariatric centers in order to establish the incidence and to evaluate the different treatments of this complication.

Methods

We retrospectively studied 13 patients which developed GBF after LSG performed between March 2007 and August 2012. Patients were separated into two groups: patients who had early gastric fistula which has evolved into a GBF (group 1) and patients who had a late gastric fistula, either directly GBF or a late gastric fistula evolved in GBF (group 2).

Results

Group 1 consisted of five patients and group 2 of eight patients. All patients were undernourished at diagnosis. Management of GBF was a combined thoraco-abdominal surgery with gastrojejunal anastomosis (n = 5) or total gastrectomy (n = 1), multiple endoscopic treatment and thoracic surgery (n = 3), an endobronchial valve (n = 1), total gastrectomy and thoracic drainage (n = 1), and transorificial intubation with thoracic surgery or drainage (n = 2). There was no mortality. All GBF healed.

Conclusions

GBF after LSG is a serious complication which is not anecdotal. Most of the early gastric fistulas occuring after LSG become chronic and can evolve into a GBF. Surgical approach is an effective treatment. Endobronchial valve is a novel alternative.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–23. discussion 524.

    Article  CAS  PubMed  Google Scholar 

  2. Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19:1672–7.

    Article  PubMed  Google Scholar 

  3. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18:560–5.

    Article  CAS  PubMed  Google Scholar 

  4. Gagniere J, Slim K, Launay-Savary MV, et al. Previous gastric banding increases morbidity and gastric leaks after laparoscopic sleeve gastrectomy for obesity. J Visceral Surg. 2011;148:e205–9.

    Article  CAS  Google Scholar 

  5. Moszkowicz D, Arienzo R, Khettab I, et al. Sleeve gastrectomy severe complications: is it always a reasonable surgical option? Obes Surg. 2013;23:676–86.

    Article  PubMed  Google Scholar 

  6. Miwa K, Takamori S, Hayashi A, et al. Gastrobronchial fistula after esophagectomy. Eur J Cardiothorac Surg. 2004;25:460.

    Article  PubMed  Google Scholar 

  7. Gaensler EH, Jeffrey Jr RB, Noonan CD. Gastrobronchial fistula: an unusual complication of Nissen fundoplication. Gastrointest Radiol. 1988;13:6–8.

    Article  CAS  PubMed  Google Scholar 

  8. Jeganathan R, Pore N, Clements WD. Gastrobronchial fistula—a complication of splenectomy. Ulster Med J. 2004;73:126–8.

    PubMed Central  CAS  PubMed  Google Scholar 

  9. Campos JM, Siqueira LT, Meira MR, et al. Gastrobronchial fistula as a rare complication of gastroplasty for obesity: a report of two cases. J Bras Pneumol. 2007;33:475–9.

    Article  PubMed  Google Scholar 

  10. Albanopoulos K, Tsamis D, Leandros E. Gastrobronchial fistula as a late complication of sleeve gastrectomy. Surg Obes Relat Dis. 2013;9:e97–9.

    Article  PubMed  Google Scholar 

  11. Chin PL. Gastrobronchial fistula as a complication of laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4:671–3.

    Article  PubMed  Google Scholar 

  12. Fuks D, Dumont F, Berna P, et al. Case report-complex management of a postoperative bronchogastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:261–4.

    Article  PubMed  Google Scholar 

  13. Campos JM, Siqueira LT, Ferraz AA, et al. Gastrobronchial fistula after obesity surgery. J Am Coll Surg. 2007;204:711.

    Article  PubMed  Google Scholar 

  14. Alharbi SR. Gastrobronchial fistula a rare complication post laparoscopic sleeve gastrectomy. Ann Thorac Med. 2013;8:179–80.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Sakran N, Assalia A, Keidar A, et al. Gastrobronchial fistula as a complication of bariatric surgery: a series of 6 cases. Obes Facts. 2012;5:538–45.

    Article  PubMed  Google Scholar 

  16. Moeller DD, Carpenter PR. Gastrobronchial fistula: case report and review of the English literature. Am J Gastroenterol. 1985;80:538–41.

    CAS  PubMed  Google Scholar 

  17. Serra C, Baltasar A, Perez N, et al. Total gastrectomy for complications of the duodenal switch, with reversal. Obes Surg. 2006;16:1082–6.

    Article  PubMed  Google Scholar 

  18. Eisendrath P, Cremer M, Himpens J, et al. Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgery. Endoscopy. 2007;39:625–30.

    Article  CAS  PubMed  Google Scholar 

  19. Garrett KA, Rosati C. Gastro-broncho-pleural fistula after laparoscopic gastric band placement. Obes Surg. 2009;19:941–3.

    Article  PubMed  Google Scholar 

  20. Abraham A, Virdi RP, Rajan D et al. Gastrobronchial fistula following laparoscopic sleeve gastrectomy. BMJ Case Rep. 2012; 2012

  21. Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21:1520–9.

    Article  PubMed  Google Scholar 

  22. 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;9:856–61.

    Article  PubMed  Google Scholar 

  23. Casella G, Soricelli E, Rizzello M, et al. Nonsurgical treatment of staple line leaks after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19:821–6.

    Article  CAS  PubMed  Google Scholar 

  24. Csendes A, Braghetto I, Leon P, et al. Management of leaks after laparoscopic sleeve gastrectomy in patients with obesity. J Gastrointest Surg. 2010;14:1343–8.

    Article  PubMed  Google Scholar 

  25. Tan JT, Kariyawasam S, Wijeratne T, et al. Diagnosis and management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg. 2010;20:403–9.

    Article  PubMed  Google Scholar 

  26. Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145:106–13.

    Article  PubMed  Google Scholar 

  27. Pequignot A, Fuks D, Verhaeghe P, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy? Obes Surg. 2012;22:712–20.

    Article  CAS  PubMed  Google Scholar 

  28. Bege T, Emungania O, Vitton V, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc. 2011;73:238–44.

    Article  PubMed  Google Scholar 

  29. Nedelcu AM, Skalli M, Deneve E, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9:879–84.

    Article  PubMed  Google Scholar 

  30. Baltasar A, Bou R, Bengochea M, et al. Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17:1408–10.

    Article  PubMed  Google Scholar 

  31. De Giacomo T, Venuta F, Diso D, et al. Successful treatment with one-way endobronchial valve of large air-leakage complicating narrow-bore enteral feeding tube malposition. Eur J Cardiothorac Surg. 2006;30:811–2.

    Article  PubMed  Google Scholar 

  32. Travaline JM, McKenna Jr RJ, De Giacomo T, et al. Treatment of persistent pulmonary air leaks using endobronchial valves. Chest. 2009;136:355–60.

    Article  PubMed  Google Scholar 

  33. Brichon PY, Poquet C, Arvieux C, et al. Successful treatment of a life-threatening air leakage, complicating severe abdominal sepsis, with a one-way endobronchial valve. Interact Cardiovasc Thorac Surg. 2012;15:779–80.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflicts of Interest

The authors have declared no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery—Pôle digi-DUNE—University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France

    Antoine Guillaud, Aurélien Caballero-Caballero, Fabian Reche, Julio Abba & Catherine Arvieux

  2. Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, University Paris 5, Hôpital Européen Georges Pompidou, Paris, France

    David Moszkowicz

  3. Department of Surgery, Saint Eloi Hospital-CHRU Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier Cedex 5, France

    Marius Nedelcu

  4. Department of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France

    Lionel Rebibo

Authors
  1. Antoine Guillaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Moszkowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marius Nedelcu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aurélien Caballero-Caballero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lionel Rebibo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fabian Reche
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Julio Abba
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Catherine Arvieux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine Arvieux.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guillaud, A., Moszkowicz, D., Nedelcu, M. et al. Gastrobronchial Fistula: A Serious Complication of Sleeve Gastrectomy. Results of a French Multicentric Study. OBES SURG 25, 2352–2359 (2015). https://doi.org/10.1007/s11695-015-1702-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-015-1702-y

Keywords

Search

Navigation