Endoscopic fibrin sealing of high-output non-healing gastrocutaneous fistulas after vertical gastroplasty in morbidly obese patients

• Published in: Obesity surgery Vol. 11; no. 6; pp. 766 - 769
• Main Authors: Papavramidis, S T, Eleftheriadis, E E, Apostolidis, D N, Kotzampassi, K E
• Format: Journal Article
• Language: English
• Published: United States Springer Nature B.V 01.12.2001
• Subjects: Adult; Cutaneous Fistula - etiology; Cutaneous Fistula - therapy; Endoscopy, Gastrointestinal; Female; Fibrin Tissue Adhesive - therapeutic use; Gastric Fistula - etiology; Gastric Fistula - therapy; Gastrointestinal surgery; Gastroplasty; Humans; Male; Middle Aged; Obesity; Obesity, Morbid - surgery; Postoperative Complications - therapy; Sepsis - etiology; Treatment Outcome; Weight control
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1381/09608920160558759

Fibrin glue was used in a various fields of surgery during the last 15 years, but its use has not been reported in bariatric surgery yet. In 2 out of 215 morbidly obese patients who underwent vertical banded gastroplasty, a non-healing gastrocutaneus fistula (GCF) developed. In both patients sepsis occurred, caused by a leak of the posterior gastric wall, which was managed by means of an unsuccessful reoperation. After that, sepsis recurred, and a non-healing GCF developed. These GCF were managed endoscopically by the use of a fibrin sealant (Beriplast P 2 ml set, Behring) as a tissue adhesive. One injection was needed for the first case and six for the second in achieving full healing of the fistulas. No evidence of fistula was observed at gastroscopy 3 and 24 months after the end of therapy. Endoscopic use of human fibrin sealant is simple, safe, effective and in some cases life-saving. This is a therapeutic option in high output GCF in morbidly obese patients.