Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy.
BACKGROUND
Gastric fistula (GF) is a serious complication after laparoscopic sleeve gastrectomy (LSG). Furthermore, gastrobronchial fistula (GBF) may appear some time after a primary LSG. The objective of this study was to characterize GBF after LSG and establish standardized treatment procedures.


METHODS
All patients undergoing surgery for GBF after LSG at a public university medical center in France between November 2004 and January 2013 were included in this study. Surgical and perioperative care was standardized. The primary efficacy criterion was the complication rate. Secondary efficacy criteria were the mortality rate, surgical data, types of complications, and the length of stay (LOS) in hospital.


RESULTS
Six patients were treated for GBF after LSG: 2 presented GBF after primary LSG performed in our institution and 4 had been referred by tertiary centers. The median (range) time to onset of GBF after LSG was 136 days (99-238 d). Preoperative refeeding was performed in 5 cases. The median time interval between the discovery of GBF and its surgical treatment was 31 days (7-137 d). Five patients underwent simultaneous abdominal and thoracic procedures. The abdominal procedures consisted of total gastrectomy (n = 1) and 60-cm Roux-en-Y gastrojejunal anastomosis (n = 6). There were no postoperative mortalities. Four postoperative complications occurred (66.6%), 2 of which were postoperative fistulas (33.3%) requiring revisional surgery. The median time to oral refeeding was 10 days (8-65 d) and the median LOS was 14 days (13-25 d).


CONCLUSIONS
Our treatment of GBF is based on effective drainage with endoscopic procedures, allowing optimal preoperative refeeding before combined abdominal and thoracic surgery. For the abdominal procedure, we prefer a 60-cm Roux-en-Y gastrojejunal anastomosis to total gastrectomy, because the former is simpler and minimizes the long-term risk of postoperative malabsorption.
Departments of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
Lionel
L
Rebibo
Departments of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
Abdennaceur
A
Dhahri
Departments of Thoracic Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
Pascal
P
Berna
Departments of Radiology, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
Thierry
T
Yzet
Departments of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
Pierre
P
Verhaeghe
Departments of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
Jean-Marc
JM
Regimbeau
D000328:Adult; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
Gastric fistula; Gastrobronchial fistula; Laparoscopic sleeve gastrectomy; Roux-en-Y gastrojejunal anastomosis; Thoracic surgery