Laparoscopic Roux-en-Y fistulojejunostomy as a salvage procedure in patients with chronic gastric leak after sleeve gastrectomy

Published:December 10, 2022DOI:


      • Management of chronic gastric staple-line leaks (> 12 weeks) after LSG remains challenging.
      • Fourteen patients with chronic gastric leak post-LSG were treated with salvage laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ).
      • LRYFJ seems to be a good surgical option for the treatment of chronic gastric leaks after LSG.
      • It is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.
      • Careful patient selection is essential since this approach should only be considered in patients with adequate nutritional status and after failure of a well conducted endoscopic management.



      The most common postoperative complication of laparoscopic sleeve gastrectomy (LSG) is staple-line leak. Even if its rate following LSG has been recently reduced, management of chronic leaks remains challenging.


      To present a series of patients treated with laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ) for chronic gastric leak (>12 wk) post-LSG.


      University hospitals; specialized bariatric surgery units.


      Data were prospectively gathered and retrospectively analyzed. Parameters of interest were patient characteristics, perioperative data, and postoperative outcomes. Hemodynamically unstable patients and/or presentations of signs of severe sepsis were excluded. Surgical technique was standardized.


      Fourteen patients underwent LRYFJ for chronic gastric leak (12 women, 2 men). The mean age was 49.2 years and the mean weight was 88.7 kg with a mean body mass index of 31.1 kg/m2. All procedures were successfully performed by laparoscopy except 1 (7.1%) converted to open surgery. The mean operative time was 198 minutes, with a mean estimated blood loss of 135.7 mL and 2 patients necessitating transfusion (14.2%). Mortality was null. Five postoperative complications were noted (35.7%): 2 leaks of the fistulojejunostomy treated by antibiotherapy and endoscopic drainage; 1 perianastomotic hematoma treated by relaparoscopy and antibiotherapy; and 1 pleural effusion and 1 hematemesis both medically treated. The mean length of hospital stay was 14 days. The mean follow-up was 40 months, with all patients being in good health at last contact.


      LRYFJ seems to be a good salvage option in selected patients for the treatment of chronic gastric leaks after LSG. However, it is a challenging procedure and should be performed in experienced bariatric centers by expert bariatric surgeons.


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        • Huang H.
        • Yan Z.
        • Chen Y.
        • Liu F.
        A social contagious model of the obesity epidemic.
        Sci Rep. 2016; 637961
        • Palermo M.
        • Gagner M.
        Why we think laparoscopic sleeve gastrectomy is a good operation: step-by-step technique.
        J Laparoendosc Adv Surg Tech A. 2020; 30: 615-618
        • Iannelli A.
        • Treacy P.
        • Sebastianelli L.
        • Schiavo L.
        • Martini F.
        Perioperative complications of sleeve gastrectomy: review of the literature.
        J Minim Access Surg. 2019; 15: 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: 13904-13910
        • Yu J.X.
        • Schulman A.R.
        Management of a refractory leak after sleeve gastrectomy: the endoscopic armamentarium.
        VideoGIE. 2019; 4: 372-374
        • Nedelcu M.
        • Danan M.
        • Noel P.
        • Gagner M.
        • Nedelcu A.
        • Carandina S.
        Surgical management for chronic leak following sleeve gastrectomy: review of literature.
        Surg Obes Relat Dis. 2019; 15: 1844-1849
        • Lainas P.
        • Tranchart H.
        • Gaillard M.
        • Ferretti S.
        • Donatelli G.
        • Dagher I.
        Prospective evaluation of routine early computed tomography scanner in laparoscopic sleeve gastrectomy.
        Surg Obes Relat Dis. 2016; 12: 1483-1490
        • Aurora A.R.
        • Khaitan L.
        • Saber A.A.
        Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients.
        Surg Endosc. 2012; 26: 1509-1515
        • Gagner M.
        • Hutchinson C.
        • Rosenthal R.
        Fifth International Consensus Conference: current status of sleeve gastrectomy.
        Surg Obes Relat Dis. 2016; 12: 750-756
        • Dammaro C.
        • Lainas P.
        • Dumont J.L.
        • Tranchart H.
        • Donatelli G.
        • Dagher I.
        Endoscopic internal drainage coupled to prompt external drainage mobilization is an effective approach for the treatment of complicated cases of sleeve gastrectomy.
        Obes Surg. 2019; 29: 2929-2935
        • Gonzalez J.M.
        • Lorenzo D.
        • Guilbaud T.
        • Bege T.
        • Barthet M.
        Internal endoscopic drainage as first line or second line treatment in case of postsleeve gastrectomy fistulas.
        Endosc Int Open. 2018; 6: E745-E750
        • Bashah M.
        • Khidir N.
        • El-Matbouly M.
        Management of leak after sleeve gastrectomy: outcomes of 73 cases, treatment algorithm and predictors of resolution.
        Obes Surg. 2020; 30: 515-520
        • Lainas P.
        • Schoucair N.
        • Dammaro C.
        • Dagher I.
        Salvage procedures for chronic gastric leaks after sleeve gastrectomy: the role of laparoscopic Roux-en-Y fistulo-jejunostomy.
        Ann Transl Med. 2019; 7: S119
        • Baltasar A.
        • Bou R.
        • Bengochea M.
        • Serra C.
        • Cipagauta L.
        Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy.
        Obes Surg. 2007; 17: 1408-1410
        • Amor I.B.
        • Lainas P.
        • Kassir R.
        • et al.
        Laparoscopic Roux-en-Y Double fistulo-jejunostomy for chronic gastric leaks after converted vertical banded gastroplasty to sleeve gastrectomy.
        Obes Surg. 2020; 30: 378-380
        • Vilallonga R.
        • Himpens J.
        • van de Vrande S.
        Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects.
        Surg Endosc. 2015; 29: 414-416
        • Chouillard E.
        • Younan A.
        • Alkandari M.
        • et al.
        Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results.
        Surg Endosc. 2016; 30: 4200-4204
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Donatelli G.
        • Spota A.
        • Cereatti F.
        • et al.
        Endoscopic internal drainage for the management of leak, fistula, and collection after sleeve gastrectomy: our experience in 617 consecutive patients.
        Surg Obes Relat Dis. 2021; 17: 1432-1439
        • Welbourn R.
        • Pournaras D.J.
        • Dixon J.
        • et al.
        Bariatric Surgery Worldwide: baseline demographic description and one-year outcomes from the Second IFSO Global Registry Report 2013–2015.
        Obes Surg. 2018; 28: 313-322
        • Rosenthal R.J.
        • International Sleeve Gastrectomy Expert P.
        • Diaz A.A.
        • 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: 8-19
        • Rogalski P.
        • Swidnicka-Siergiejko A.
        • Wasielica-Berger J.
        • et al.
        Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis.
        Surg Endosc. 2021; 35: 1067-1087
        • Rebibo L.
        • Tricot M.
        • Dembinski J.
        • Dhahri A.
        • Brazier F.
        • Regimbeau J.M.
        Gastric leak after sleeve gastrectomy: risk factors for poor evolution under conservative management.
        Surg Obes Relat Dis. 2021; 17: 947-955
        • Sakran N.
        • Goitein D.
        • Raziel A.
        • et al.
        Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients.
        Surg Endosc. 2013; 27: 240-245
        • Chouillard E.
        • Chahine E.
        • Schoucair N.
        • et al.
        Roux-En-Y Fistulo-Jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula.
        Surg Endosc. 2014; 28: 1954-1960
        • Rayman S.
        • Staierman M.
        • Ben-David M.
        • et al.
        Laparoscopic revision to total gastrectomy or fistulo-jejunostomy as a definitive surgical procedure for chronic gastric fistula after laparoscopic sleeve gastrectomy.
        Surg Obes Relat Dis. 2020; 16: 1893-1900