Gastropleural fistula after bariatric surgery: a report of two cases

Gastropleural fistulas (GPF) were first described by Markowitz and Herter in 1960. These are uncommon entities and can occur as a consequence of pulmonary surgery, trauma, malignancy, hiatal hernia, infections, Nissen fundoplication and most recently, bariatric surgery. Many treatments have been used for GPF, such as conservative management with antibiotics, parenteral nutrition, percutaneous drainage of collections and endoscopic therapies, but these usually fail and may lead to complex surgical procedures.

Two patients diagnosed with GPF after bariatric surgeries were treated in our program. After failure of conservative management, both were subjected to laparoscopic-robotic assisted gastropleural fistula resection. Case 1 was a patient who had a sleeve gastrectomy 1 year prior, required partial esophagogastrectomy and esophagojejunal anastomosis. Case 2 had an open gastric bypass 13 years prior, and when medical resolution of fistula was not possible, he underwent a partial remnant gastrectomy and hiatal hernia repair.

Appearance of gastroplueral fistula after bariatric surgery is a rare occurrence. When surgical management is needed, we have noticed that the use of the robotic platform in these complex surgical cases is safe and feasible.