Gastric Fistula After Sleeve Gastrectomy: Clinical Features and Treatment Options
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Gastric Fistula After Sleeve Gastrectomy: Clinical Features and Treatment Options Álvaro A. B. Ferraz 1,2 & Pedro Henrique F. Feitosa 3 & Fernando Santa-Cruz 4 & Maria-Améllia R. Aquino 4 & Luca T. Dompieri 4 & Eryka M. Santos 3 & Luciana T. Siqueira 2 & Flávio Kreimer 2 Received: 13 October 2020 / Revised: 4 November 2020 / Accepted: 10 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To trace the clinical profile of fistula cases after sleeve gastrectomy (SG) and evaluate the efficacy and safety of endoscopic treatments and the admission costs of these patients. Methods This is a retrospective study of patients who developed gastric fistulas after SG. All patients were submitted to surgical and/or endoscopic interventions (self-expandable stent, septotomy, and balloon dilation). The main studied variables were need for reoperation, number of endoscopic procedures, endoscopic complications, time until fistula diagnosis, fistula location, time until resolution, length of hospital stay, and health costs. Results The sample was mainly female (76.2%) with a mean age of 39.5 years and a BMI of 39.6 kg/m2. In 90.5% of cases, the fistula occurred in the topography of the His angle. Thirteen patients required surgical intervention. Of the patients who underwent endoscopic interventions, it was necessary to place more than one self-expandable stent of a maximum duration of 4 weeks. Six patients underwent more than two sessions of septotomy. There was one case of bleeding after septotomy. Dilatation was required in 71.4% of patients and an average of two sessions (1–5) per patient. The diagnosis of fistula occurred 14.4 days after surgery. The average time to resolve fistulas was 50.6 days. The average hospital stay was 75.8 days. The total cost of hospitalization was on average US$ 75,180.00. Conclusion The surgical and endoscopic treatment of gastric fistulas after SG was safe and effective. There was a very low rate of complications. The time of onset of fistulas was not decisive for patient improvement. Keywords Sleeve gastrectomy . Bariatric surgery . Fistula . Gastric leak . Endoscopic procedures . Surgical complications
Introduction Sleeve gastrectomy (SG) is the most widely performed bariatric surgery technique in the USA. It accounted for
approximately 61% of bariatric procedures in 2018 [1, 2]. Despite being a relatively simple surgery compared with Roux-en-Y gastric bypass (RYGB), it has no negligible risk of postoperative complications. Among them, gastric fistulas
* Álvaro A. B. Ferraz [email protected]
Luciana T. Siqueira [email protected] Flávio Kreimer [email protected]
Pedro Henrique F. Feitosa [email protected] 1
Gastrointestinal Surgery Unit, Hospital Esperança – Rede D’Or São Luiz, Recife, PE, Brazil
2
Department of Surgery, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil
Luca T. Dompieri [email protected]
3
Post-graduatio
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