Laparoscopic Management of Chronic Pouch Fistula After a Leak Following Staple Line Dehiscence After Laparoscopic Revision of a Dilated Pouch Following Roux-en-Y Gastric Bypass

Tucker, Olga; Szomstein, Samuel; Rosenthal, Raúl J.

doi:10.1007/s11695-007-9270-4

Cited by 7 publications

(4 citation statements)

References 35 publications

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“…In these patients, Suture-line reinforcement, at least selectively in the middle-upper portion of the staple line and in super-super-obese patients, is recommended to decrease the incidence of specific complications such as fistula [36]. Other authors have performed a laparoscopic fistulotomy with debridement [37]. …”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)

Vilallonga

Fort

González

et al. 2010

Diagnostic and Therapeutic Endoscopy

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Background. Drain inclusion inside the gastric pouch is rare and can represent an important source of morbidity and mortality associated with laparocopic Roux-en-Y gastric bypass (LRYGBP). These leaks can become chronic and challenging. Surgical options are often unsuccessful. We present the endoscopic management of four patients with drain inclusion. Patients. All four obese morbidly patients underwent LRYGBP and presented a gastro-jejunal fistula after acute anastomotic leakage. During follow-up endoscopy the drain was found inside the gastric pouch. It was moved into the abdominal cavity. Fistula debit reduced significantly and closed. Results. Gastric leak closure in less than 24 hours was achieved in all, with complete resolution of symptoms. These patients benefited exclusively from endoscopic treatment. Conclusions. Endoscopy is useful and technically feasible in chronic fistulas. This procedure is a less invasive alternative to traditional surgical revision. Other therapeutic strategies can be used such as clips and fibrin glue. Drains should not be placed in contact with the anastomosis or stapled lines. Drain inclusion must be suspected when fistula debit suddenly arises. If so, endoscopy is indicated for diagnostic accuracy. Under endoscopy vision, the drain is gently removed from the gastric reservoir leading to sudden and complete resolution of the fistula.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)

Vilallonga

Fort

González

et al. 2010

Diagnostic and Therapeutic Endoscopy

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“…In the case of leaks after a Roux-en-Y gastric bypass (RYGBP), there have been different alternatives described to prevent and treat them with variable results [23][24][25][26][27][28]. In contrast to RYGBP, LSG leaks are more difficult to manage due to the presume of saliva, acid, and bile that might worsen the degree of peritonitis because the specific presence of bile, gastric acid, or both potential collections.…”

Section: Discussionmentioning

confidence: 99%

T-Tube Gastrostomy as a Novel Approach for Distal Staple Line Disruption after Sleeve Gastrectomy for Morbid Obesity: Case Report and Review of the Literature

et al. 2009

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Laparoscopic sleeve gastrectomy has recently become a feasible option in the management of morbid obesity. One of the most feared complications of this procedure is staple line disruption and leakage. There are, to our knowledge, few literature reports that try to explain the reasons and management of this rare but serious complication. We report a case of staple line disruption that was managed using a T-tube gastrostomy. A 50-year-old female, 2 weeks status post-sleeve gastrectomy in an outside facility, was admitted to the emergency room at Cleveland Clinic Florida with new onset of fever, abdominal pain, jaundice, hematemesis, and melena. A computed tomography scan of the abdomen revealed a large extravasation of contrast material parallel to the gastric sleeve. A diagnostic laparoscopy was performed that showed a distal and proximal disruption of the staple line. A T-tube gastrostomy with a large proximal and distal limb was placed into the most distal area of disruption. After thorough over sewing and drainage of the proximal site and T-tube, a feeding jejunostomy was placed. The T-tube permitted to control the leak and to have a controlled fistula. Four weeks postoperatively, the T-tube was removed after the patient had a negative Gastrografin study and tolerated oral fluids with a clamped T-tube. The long-term recovery and follow-up were uneventful. T-tube gastrostomy appears to be a safe and feasible treatment option for staple line disruption after vertical sleeve gastrectomy. Early detection and drainage remain the most important principles to manage this type of complication.

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“…While longer limb RYGBs produce more rapid weight loss, they are also associated with a higher incidence of malnutrition, and there is no significant difference in weight loss at 5 years compared with those patients who have a standard limb length [6]. Revision bariatric surgery can be technically demanding and lead to serious complications [7,8]. It has been demonstrated that the insertion of a silastic ring around the gastric pouch at the time of RYGB can prevent long-term weight regain by restricting the size of the outlet to the gastric pouch [9].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Insertion of a Gastric Band for Weight Gain Following Laparoscopic Roux-en-Y Gastric Bypass: Description of the Technique

2008

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Laparoscopic Management of Chronic Pouch Fistula After a Leak Following Staple Line Dehiscence After Laparoscopic Revision of a Dilated Pouch Following Roux-en-Y Gastric Bypass

Abstract: A super-obese male underwent laparoscopic gastric bypass. The gastric pouch dilated, with weight gain. The pouch was revised, followed by a leak, tracking through left diaphragm. Eventually, fistulotomy with debridement was necessary, followed by uneventful recovery.

Cited by 7 publications

References 35 publications

Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)

Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)

T-Tube Gastrostomy as a Novel Approach for Distal Staple Line Disruption after Sleeve Gastrectomy for Morbid Obesity: Case Report and Review of the Literature

Laparoscopic Insertion of a Gastric Band for Weight Gain Following Laparoscopic Roux-en-Y Gastric Bypass: Description of the Technique

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