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Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula
Almino Cardoso Ramos1, Manoela Galvão Ramos1, Josemberg Marins Campos2
1Gastro Obeso Center, Advanced Institute for Digestive and Bariatric Surgery, Sao Paulo, Brazil.
Background:
Sleeve gastrectomy (SG) has become a very common 1-stage procedure in bariatric surgery. Postsleeve chronic fistulas could be one of the possible complications and represent a true challenge for the surgeons. After the failure of more conservative treatments, including surgical and endoscopic approaches, laparoscopic total gastrectomy (LTG) could be an alternative treatment proposal. The objective of this study was to evaluate outcomes of patients who underwent laparoscopic total gastrectomy for the treatment of postsleeve chronic fistula.
Methods:
Retrospectively review the data from patients after LTG for postsleeve chronic fistula who had failed in all previous treatment attempts with a combination of conservative, endoscopic, and/or surgical approach.
Results:
From January 2008 to December 2012, 12 patients underwent LTG. Mean time from SG to LTG was 16 months (ranged from 6 to 30). All patients had undergone several previous treatment attempts, including endoscopic techniques (fibrin glue, clips, pneumatic dilation, and stents) and surgical procedures for abscess drainage. Surgical time ranged from 4 to 7 hours with a mean hospital stay of 6 days. Complications occurred in 2 patients (17%) with 1 revision as a result of an intestinal occlusion. There were no conversions to open surgery, anastomotic leaks, or deaths.
Conclusions:
LTG was feasible in the management of postsleeve chronic fistulas recalcitrant to other treatment approaches with a few complications and high rate of resolution.
