Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch
- 28 November 2008
- journal article
- case report
- Published by Wiley in Journal of Gastroenterology and Hepatology
- Vol. 23 (12), 1802-1805
- https://doi.org/10.1111/j.1440-1746.2008.05545.x
Abstract
Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5-3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery.Keywords
This publication has 29 references indexed in Scilit:
- Closure of a Nonhealing Gastrocutaneous Fistula Using an Endoscopic ClipSouthern Medical Journal, 2007
- Banded gastric bypass: Combining two principlesSurgery for Obesity and Related Diseases, 2005
- Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealantGastrointestinal Endoscopy, 2004
- Laparoscopic Versus Open Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and CostsAnnals of Surgery, 2001
- Artificial Nutritional Support in Patients with Gastrointestinal FistulasWorld Journal of Surgery, 1999
- GENERAL MANAGEMENT OF GASTROINTESTINAL FISTULAS: Recognition, Stabilization, and Correction of Fluid and Electrolyte ImbalancesSurgical Clinics of North America, 1996
- SURGICAL MANAGEMENT AND TREATMENT OF GASTRIC AND DUODENAL FISTULASSurgical Clinics of North America, 1996
- SURGICAL MANAGEMENT AND TREATMENT OF SEPSIS ASSOCIATED WITH GASTROINTESTINAL FISTULASSurgical Clinics of North America, 1996
- PREFACESurgical Clinics of North America, 1996
- Gastric Fistula Following SplenectomyAnnals of Surgery, 1977