Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular bariatric procedure. A chronic fistula at the esophago-gastric junction (EGJ) is a rare but life-threatening complication of this procedure whose causes are still unclear and management is still controversial.

Methods: A 41-year-old woman with a body mass index (BMI) of 38 developed an EGJ leak 6 days post-LSG. Despite initial control with conservative measures, the leak persisted and resulted in a left pleural abscess and a broncho-pleural fistula requiring thoracotomy with resection of the abscessed lung parenchyma. Endoscopic and drainage procedures failed to prevent subdiaphragmatic recurring collection due to the persistent fistula. Nineteen months after LSG, a Roux limb was placed on the EGJ and sutured side to side around the fistula defect, without mucosa-to-mucosa anastomosis.

Results: The postoperative course was uneventful and, 20 months later (39 months post-LSG), the patient is well with a BMI of 27.

Conclusions: Laparoscopic apposition of a Roux-en-Y limb without mucosa-to-mucosa anastomosis as an efferent path to drain the undebrided fistula defect can effectively treat chronic leaks at the EGJ after LSG.