Laparoscopic Roux-en-Y Double Fistulo-Jejunostomy for Chronic Gastric Leaks After Converted Vertical Banded Gastroplasty
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MULTIMEDIA ARTICLE
Laparoscopic Roux-en-Y Double Fistulo-Jejunostomy for Chronic Gastric Leaks After Converted Vertical Banded Gastroplasty to Sleeve Gastrectomy Imed Ben Amor 1,2,3 & Panagiotis Lainas 4,5 Ibrahim Dagher 4,5 & Jean Gugenheim 1,2,3
&
Radwan Kassir 4 & Jean Hubert Etienne 1 & Vincent Casanova 1 &
# Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background As laparoscopic sleeve gastrectomy (LSG) is becoming the most popular bariatric procedure worldwide, treatment options for managing complications, in particular gastric leaks, are also emerging. Staple line leak is a major short-term complication of the procedure. Patients with persistent gastric leaks after failure of endoscopic and radiologic management are candidates for salvage surgery. Laparoscopic Roux-en-Y fistulo-jejunostomy (RYFJ) represents a surgical option to treat persistent gastric leak post-LSG. Methods We present the case of a 55-year-old woman undergoing laparoscopic double RYFJ for persistent gastric leaks after complicated bariatric surgery. The patient developed two chronic gastric leaks (gastro-esophageal and cardial localizations) following conversion to sleeve gastrectomy for failed vertical banded gastroplasty. With the two leaks being refractory to endoscopic treatment 6 months later after laparoscopic sleeve gastrectomy, salvage surgery was proposed. Surgery was performed laparoscopically, the gastric leak orifices were identified after careful dissection, and a double RYFJ was successfully completed. Results Postoperative course was uneventful. The patient remains in good health 6 months after surgery. Conclusions Double LRYFJ for chronic leaks after complicated bariatric procedures seems safe with good postoperative outcomes. However, it remains a challenging procedure and should be reserved for selected patients in specialized bariatric centers. Keywords Bariatric surgery . Surgical technique . Roux-En-Y fistulo-jejunostomy . Sleeve gastrectomy . Vertical banded gastroplasty . Chronic fistula . Laparoscopy
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-019-04255-y) contains supplementary material, which is available to authorized users. * Panagiotis Lainas [email protected] 1
Department of Digestive Surgery, Archet II Hospital, Nice, France
2
University of Nice-Sophia-Antipolis, Nice, France
3
INSERM U1081, Nice, France
4
Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique – Hôpitaux de Paris, F-92140 Clamart, France
5
Paris-Saclay University, F-91405 Orsay, France
OBES SURG
Introduction As laparoscopic sleeve gastrectomy (LSG) is becoming the most popular bariatric procedure worldwide, treatment options for managing complications, in particular gastric leaks, are also emerging [1]. The incidence of leaks in the literature is reported to be between 1 and 6% [2]. Key steps in the management of leaks are infection control (by broad-spectrum antibiotic therapy), fistula c
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