Chronic Fistula After Revision Laparoscopic Sleeve Gastrectomy

Giuseppe S. Sica, MD, PhD, Marco D’Eletto, MD, Cristina Fiorani, MD, Andrea Divizia, MD, Paolo Gentileschi, MD, Domenico Benavoli, MD, Manfredi Tesauro, MD, PhD, Achille L. Gaspari, MD

Department of General Surgery, Tor Vergata University of Rome, Rome, Italy (all authors).

ABSTRACT

Laparoscopic sleeve gastrectomy (LSG) is a safe and effective bariatric surgery procedure. Leaks along the staple line are serious complications of the procedure and can result in significant morbidity. Treatment depends on the timing, site, and clinical consequence of the leak. We describe the case of a young, formerly obese woman who presented with a chronic gastric fistula at the esophagogastric junction after an LSG. Treatment of this complication required multiple interventions by a highly specialized team. Physicians’ decision-making was difficult throughout the entire process, and complete healing of the fistula was accomplished 20 months after the LSG. A multidisciplinary approach is mandatory in the treatment of a chronic fistula from LSG, but there is no standard treatment strategy.

Key Words: Morbid obesity, Laparoscopy, Sleeve gastrectomy.

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