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Total Gastrectomy with Roux-en-Y Limb Reconstruction for Complex and Chronic Fistulas After Laparoscopic Sleeve
Laura Montana1, Fabio Frosio2, Claude Polliand3
1Department of Digestive and Metabolic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, 75012, Paris, France.
Obesity Surgery
|September 30, 2021
Summary
Total gastrectomy with Roux-en-Y reconstruction is a viable salvage for complex gastric fistulas after laparoscopic sleeve gastrectomy when conservative options fail. This approach effectively manages extensive fistulas, leading to significant BMI reduction.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Bariatric Surgery
Background:
- Chronic fistulas after laparoscopic sleeve gastrectomy (LSG) present complex management challenges.
- Optimal surgical treatment for these fistulas remains a subject of debate.
Purpose of the Study:
- To review the center's experience in treating chronic and complex gastric fistulas that developed after LSG.
- To evaluate the efficacy of total gastrectomy with Roux-en-Y reconstruction (TG) as a treatment for these fistulas.
Main Methods:
- A retrospective analysis of 13 patients who underwent open TG for LSG-related chronic fistulas between 2013 and 2018.
- Data collected included fistula type, surgical procedures, complications, and body mass index (BMI) changes.
Main Results:
- The 13 patients presented with various fistula types, including gastro-cutaneous, gastro-splenic, gastro-pleural, and gastro-bronchial.
- Five patients (38.5%) experienced early complications; two had esophago-jejunal anastomotic leaks treated conservatively.
- Mean BMI decreased significantly from 36 kg/m² before LSG to 23.5 kg/m² two years after TG.
Conclusions:
- Open total gastrectomy with esophago-jejunostomy is a valuable salvage procedure for complex and extensive gastric fistulas post-LSG.
- This approach is indicated when less invasive surgical options are not feasible, offering a definitive solution for challenging fistulas.
