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Use of Roux limb as remedial surgery for sleeve gastrectomy fistulas

Published:August 04, 2008DOI:https://doi.org/10.1016/j.soard.2008.07.012
      Laparoscopic sleeve gastrectomy (LSG) is a restrictive operation indicated as an isolated technique or as the first part of the laparoscopic duodenal switch [
      Clinical Issues Committee of the American Society for Metabolic and Bariatric Surgery
      Position statement: sleeve gastrectomy as a bariatric procedure.
      ,
      • Deitel M.
      • Ros C.
      • Gagner M.
      The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007.
      ,
      • Baltasar A.
      • Serra C.
      • Pérez N.
      • et al.
      Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation.
      ]. A leak at the esophageal-gastric junction (EGJ), at the uppermost part of the staple line, is, in our experience, the most common site and can lead to local abscess, septic complications, or chronic fistula. Contained leaks have less severe consequences and are usually treated by percutaneous pigtail drainage. Fibrin sealing glues, coils, coated self-expanding stents (CSESs) [
      • Salinas A.
      • Baptista A.
      • Santiago E.
      • et al.
      Self-expanding metal stents to treat gastric leaks.
      ,
      • Serra C.
      • Baltasar A.
      • Andreo L.
      • et al.
      Treatment of gastric leaks with a coated self-expanding stents after sleeve gastrectomy.
      ] or repeat operations have successfully closed these fistulas in some patients but, in others, have failed. Some patients have required total gastrectomy [
      • Serra C.
      • Baltasar A.
      • Pérez N.
      • et al.
      Total gastrectomy for complications of the duodenal switch with reversal.
      ].

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      References

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