Robot‐assisted surgery and endoscopic management of gastrocolic fistula: A rare complication of acute pancreatitis in a patient who had undergone sleeve gastrectomy

Abstract

Ten years after undergoing sleeve gastrectomy, a 39‐year‐old man developed pancreatitis and, after recovery, presented with severe diarrhea. An image study showed barium contrast passing from the stomach to the colon. Before surgery, initial treatment consisted of parenteral nutrition and antibiotics. The patient then underwent robot‐assisted resection of a gastrocolic fistula and omentoplasty. However, 72 h after surgery, the amount of suction drainage suggested that the fistulous track repair was leaking. Therefore, we decided to perform endoscopy to place a self‐expanding covered stent at the gastroesophageal junction as well as a nasojejunal tube to continue nutritional supplementation. After the patient had fasted for 2 weeks, there was no evidence of leakage in the image studies. The patient was discharged after he had clinically improved, and the stent was removed at the end of 8 weeks. The combination of robot‐assisted surgery and endoscopic management is effective for treating gastrocolic fistula.

Roux-en-Y Gastric Bypass Pouch Outlet Reduction Using Argon Plasma Coagulation

“…The most common late complication of this procedure is the recurrence of obesity and the main factors associated with this are poor diet and bad habits associated with a sedentary lifestyle [7][8][9], both of which may lead to an increase in the size of the gastric reservoir and dilation of the diameter of the gastro-jejunal anastomosis (GJA), among other consequences [10,11]. A GJA of more than 15.0 mm in diameter has thus been associated with recurrence of obesity, especially when in combination with complaints of decreased satiety or early hunger due to rapid gastric emptying [11][12][13].…”