Laparoscopic Roux-en-Y Double Fistulo-Jejunostomy for Chronic Gastric Leaks After Converted Vertical Banded Gastroplasty to Sleeve Gastrectomy

• Published in: Obesity surgery Vol. 30; no. 1; pp. 378 - 380
• Main Authors: Amor, Imed Ben, Lainas, Panagiotis, Kassir, Radwan, Etienne, Jean Hubert, Casanova, Vincent, Dagher, Ibrahim, Gugenheim, Jean
• Format: Journal Article
• Language: English
• Published: New York Springer US 2020; Springer Nature B.V
• Subjects: Endoscopy; Gastrointestinal surgery; Laparoscopy; Medicine; Medicine & Public Health; Multimedia Article; Ostomy; Surgery; Chronic fistula; Bariatric surgery; Vertical banded gastroplasty; Laparoscopy; Roux-En-Y fistulo-jejunostomy; Surgical technique; Sleeve gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-019-04255-y

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.