Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy
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ORIGINAL CONTRIBUTIONS
Roux-en-Y Gastric Bypass for the Treatment of Leak Following Sleeve Gastrectomy Olivier Degrandi 1,2 & Anamaria Nedelcu 3 & Marius Nedelcu 3,4 Caroline Gronnier 1,2
&
Agathe Simon 1,2 & Denis Collet 1,2,5 &
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Laparoscopic sleeve gastrectomy (LSG) is estimated to be its most severe complication. An aggressive management with surgical reconstructive procedures can be proposed in patients in whom all the conservative endoscopic techniques fail. The purpose of the present study was to report our experience with Roux-en-Y gastric bypass (RYGBP) as treatment for the chronic leak after LSG. Methods Between January 2013 and July 2019, 17 consecutive patients underwent RYGBP for the treatment of chronic leak after LSG. The initial intervention, the endoscopic approach and the definitive surgical repair were carefully reviewed. Results Seventeen patients (13 women) with a median age of 39 years (24–67) with a median body mass index (BMI) of 40 kg/m2 (30–52) underwent RYGBP for persistent fistula. Sixteen patients had their early LSG performed in another hospital. Eleven patients had an initial endoscopic treatment by pigtail drains following laparoscopic drainage and 6 other patients had the endoscopic stent as the first-choice line treatment. The overall average fistula diagnosis was done at 7.7 months (2–49 months) for 12 patients. For the rest of five patients, the procedure was performed almost in the acute setting (< 30 days). All procedures were performed by laparotomy but one. Five patients had a gastrojejunal anastomosis leak diagnosed by salivary flow in the drainage, but all patients were treated conservatively. No post-operative mortality was recorded. Conclusions Surgery should be considered in case of failure of the endoscopic treatment of chronic leak after LSG. Further research is needed to clearly identify the appropriate treatment, but in our experience, RYGBP approach including the leak site offers a low morbidity rate. Keywords Sleeve gastrectomy . Leak . Chronic . Reconstructive surgery . Bypass
Introduction The increasing prevalence of morbid obesity and the fact that surgery is the only effective treatment have led to an increased number of bariatric procedures. Laparoscopic sleeve gastrectomy (LSG) has become the most frequent bariatric procedure * Denis Collet [email protected] 1
Oeso-gastric Surgery Unit, Magellan University Hospital, Bordeaux, France
2
Bordeaux Medicine University, Bordeaux, France
3
Clinique Saint Michel, ELSAN, Toulon, France
4
Clinique Bouchard, ELSAN, Marseille, France
5
Oeso-gastric Surgery Unit, Magellan University Hospital, Avenue de Magellan, 33600 Pessac, France
both in France since 2011 and the United States since 2013 [1, 2]. LSG is generally considered a straightforward procedure, but the surgical technique is one of the major determinants of the postoperative complications. Gastric leak (GL) is estimated to be the most serious complicatio
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