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

Published:December 10, 2022DOI:https://doi.org/10.1016/j.soard.2022.12.017

      Highlights

      • 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.

      Abstract

      Background

      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.

      Objective

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

      Setting

      University hospitals; specialized bariatric surgery units.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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