Endoscopic fibrin sealing of high-output non-healing gastrocutaneous fistulas after vertical gastroplasty in morbidly obese patients.
BACKGROUND
Fibrin glue was used in a various fields of surgery during the last 15 years, but its use has not been reported in bariatric surgery yet.


METHODS
In 2 out of 215 morbidly obese patients who underwent vertical banded gastroplasty, a non-healing gastrocutaneus fistula (GCF) developed. In both patients sepsis occurred, caused by a leak of the posterior gastric wall, which was managed by means of an unsuccessful reoperation. After that, sepsis recurred, and a non-healing GCF developed. These GCF were managed endoscopically by the use of a fibrin sealant (Beriplast P 2 ml set, Behring) as a tissue adhesive.


RESULTS
One injection was needed for the first case and six for the second in achieving full healing of the fistulas. No evidence of fistula was observed at gastroscopy 3 and 24 months after the end of therapy.


CONCLUSIONS
Endoscopic use of human fibrin sealant is simple, safe, effective and in some cases life-saving. This is a therapeutic option in high output GCF in morbidly obese patients.
Papavramidis
S T
ST
Aristotelian University of Thessaloniki, Department of Surgery III, AHEPA Hospital, Thessaloniki, Macedonia, Greece. demec@med.auth.gr
Eleftheriadis
E E
EE
Apostolidis
D N
DN
Kotzampassi
K E
KE
D000328:Adult; D017577:Cutaneous Fistula / Q000209:etiology / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005747:Gastric Fistula / Q000209:etiology / Q000628:therapy*; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy*; D018805:Sepsis / Q000209:etiology; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive