Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention
- 4 June 2011
- journal article
- Published by Springer Science and Business Media LLC in Obesity Surgery
- Vol. 21 (10), 1520-1529
- https://doi.org/10.1007/s11695-011-0444-8
Abstract
Gastrobronchial fistula (GBF) is a serious complication following bariatric surgery, whose treatment by thoracotomy and/or laparotomy involves a high morbidity rate. We present the outcomes of endoscopic management for GBF as a helpful technique for its healing process. This is a multicenter retrospective study of 15 patients who underwent gastric bypass (n = 10) and sleeve gastrectomy (n = 5) and presented GBF postoperatively (mean of 6.7 months). Ten patients developed lung abscess and were treated by antibiotic therapy (n = 10) and thoracotomy (n = 3). Abdominal reoperation was performed in nine patients for abscess drainage (n = 9) and/or ring removal (n = 4) and/or nutritional access (n = 6). The source of the GBF was at the angle of His (n = 14). Furthermore, 14 patients presented a narrowing of the gastric pouch treated by 20 or 30 mm aggressive balloon dilation (n = 11), stricturotomy or septoplasty (n = 10) and/or stent (n = 7). Fibrin glue was used in one patient. We performed, on average, 4.5 endoscopic sessions per patient. Endotherapy led to a 93.3% (14 out of 15) success rate in GBF closure with an average healing time of 4.4 months (range, 1–10 months), being shorter in the stent group (2.5 × 9.5 months). There was no recurrence during the average 27.3-month follow-up. A patient persisted with GBF, despite the fibrin glue application, and decided to discontinue it. GBF is a highly morbid complication, which usually arises late in the postoperative period. Endotherapy through different strategies is a highly effective therapeutic option and should be implemented early in order to shorten leakage healing time.Keywords
This publication has 20 references indexed in Scilit:
- Treatment of ring slippage after gastric bypass: long-term results after endoscopic dilation with an achalasia balloon (with videos)Gastrointestinal Endoscopy, 2010
- Strictures After Laparoscopic Sleeve GastrectomySurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2010
- Endoscopic removal of dysfunctioning bands or rings after restrictive bariatric proceduresGastrointestinal Endoscopy, 2010
- Gastro-Broncho-Pleural Fistula after Laparoscopic Gastric Band PlacementObesity Surgery, 2008
- Laparoscopic Sleeve Gastrectomy—Volume and Pressure AssessmentObesity Surgery, 2008
- Fístula gastrobrônquica como complicação rara de gastroplastia para obesidade: relato de dois casosJornal Brasileiro de Pneumologia, 2007
- Endotherapy including temporary stenting of fistulas of the upper gastrointestinal tract after laparoscopic bariatric surgeryEndoscopy, 2007
- Total Gastrectomy for Complications of the Duodenal Switch, with ReversalObesity Surgery, 2006
- The Science of Stapling and LeaksObesity Surgery, 2004
- Successful treatment of intractable esophagothoracic fistula using covered self-expandable stent.2003