Late Gastropleural Fistula after the Management of Laparoscopic Sleeve Gastrectomy Leakage
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Late Gastropleural Fistula after the Management of Laparoscopic Sleeve Gastrectomy Leakage Zahra Sobhani 1
&
Nader Moein Vaziri 2 & Babak Hosseini 2 & Masood Amini 2,3
&
Maryam Setoodeh 4 & Ali Karimi 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract One of the rare but serious complications of laparoscopic sleeve gastrectomy (LSG) with significant morbidity and mortality is gastropleural fistula (GPF). Here, we present a 34-year-old woman who underwent LSG. Due to leakage in the proximal site of the stapler line and splenic artery erosion into the site of leakage after 1 month, splenectomy and drainage catheter insertion was done. Three months later, she presented with dyspnea, fever, and lung abscess, GPF was diagnosed, and Roux-en-Y fistulojejunostomy was done. After 10 days, her clinical condition improved, but the patient expired due to hemorrhagic cerebrovascular accident (CVA). Therefore, GPF along with other common complications should be seriously considered in patients developing post-LSG chronic respiratory symptoms. Keywords Gastropleural fistula . Leakage . Laparoscopic sleeve gastrectomy
Introduction In the past several decades, the prevalence of obesity has increased dramatically [1]. Bariatric or weight loss surgery is considered as the most successful treatment for morbid obesity [2]. Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric procedure for managing obesity by removing 85% of the stomach [3, 4]. Although LSG is relatively a safe surgical option, some complications have been reported in the literature [5, 6]. The gastric leak is one of the most serious complications of LSG. In a published meta-analysis, the rate of gastric leakage is 0–8% in patients following LSG [7]. Even though in recent years the occurrence of the postoperative gastrointestinal leak has been steadily
declining, it is still a complication that can lead to high morbidity and mortality [8]. Subclinical leak can be controlled either through surgical drainage or through a fistulous tract into the abdominal or chest cavity, but clinical leak is a disseminated leakage with a diffusion of the contrast into the abdominal or chest cavities [9]. Based on the time of diagnosis, the gastric leaks are classified into early or delayed leaks. An early leak is generally diagnosed within the first 3 days after surgery, whereas a delayed leak is usually diagnosed over 8 postoperative days [10]. Gastropleural fistula (GPF) is a rare and life-threatening complication of gastric sleeve surgery [11]. Here, we report a case with a late gastropleural fistula after the management of the laparoscopic sleeve gastrectomy leak.
* Masood Amini [email protected]
Ali Karimi [email protected]
Zahra Sobhani [email protected]
1
Laparoscopy research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Nader Moein Vaziri [email protected]
2
Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Ira
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