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Case Reports
. 2018 Jul;28(7):2092-2095.
doi: 10.1007/s11695-018-3241-9.

Double Baltazar Procedure for Repair of Gastric Leakage Post-Sleeve Gastrectomy from Two Sites: Case Report of New Surgical Technique

Hussein Mcheimeche  1 , Samer H Dbouk  2 , Riad Saheli  2 , Dany Lichaa  2 , Louai S Chalaby  2
Affiliations
Case Reports

Double Baltazar Procedure for Repair of Gastric Leakage Post-Sleeve Gastrectomy from Two Sites: Case Report of New Surgical Technique

Hussein Mcheimeche et al. Obes Surg. 2018 Jul.

Abstract

Background: Staple line leak is one of the most challenging complications following laparoscopic sleeve gastrectomy, with a rate reaching near 1%. Its management often implicates a multidisciplinary approach and experienced bariatric and metabolic surgeons. The literature is abundant on various approaches to treat single staple line leak with variable results. But what to do in front of an intra-op incidental finding of double gastric fistulae?

Methods: In this article, we describe a new successful surgical treatment option of double Baltazar technique for a patient who was found to have two gastric fistulae post-sleeve gastrectomy. We aim to demonstrate that this approach is safe and effective and can help avoid major side effects of traditional treatment options for such complications.

Results: The patient presented 20 days following a laparoscopic sleeve gastrectomy in a severe septic condition and was found to have a gastric leak. During surgical repair, unlike the usual single proximal fistula findings, another opening was identified more distally. Decision was made to proceed with a double fistulo-jejunostomy. It was a feasible technique, with no intra-op complications. Post-operatively, the patient had a successful recover, with no residual leak.

Conclusions: Double Baltazar technique is a successful and feasible treatment option for patients presenting with two gastric fistulae following sleeve gastrectomy. This is the first case report describing this new technique, and its success should encourage more similar trials and avoid more aggressive surgical options such as total gastrectomy or gastric bypass.

Keywords: Baltazar fistulo-jejunostomy; Double Baltazar procedure; Gastric fistula post-sleeve; Gastric leakage post-sleeve; Obesity; Sleeve gastrectomy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Upper GI showing the leak of gastrografine from the gastric fistula
Fig. 2
Fig. 2
CT scan showed perigastric tube air-fluid collection
Fig. 3
Fig. 3
Upper GI showing well-drained gastric leak
Fig. 4
Fig. 4
Laparoscopic picture showing the sites of the two gastric fistulae
Fig. 5
Fig. 5
CT scan showing contrast in the hemovac tube (tiny leak of contrast from the 1st fistulo-jejunostomy)
Fig. 6
Fig. 6
UGI showing complete healing of the fistulae
Fig. 7
Fig. 7
CT scan showing acute cholecystitis
See this image and copyright information in PMC

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