title: Laparoscopic total gastrectomy with Roux-y esophagojejunostomy for chronic gastric fistula after laparoscopic sleeve gastrectomy.
abstract: Laparoscopic sleeve gastrectomy is a restrictive operation with hormonal elements that is rapidly gaining popularity. The most feared complication of the procedure is a staple line leak. The treatment of staple line leakage depends on timing and clinical and anatomical considerations. If leakage persists and transforms into a chronic fistula, a definitive surgical procedure is required. In cases where the fistula originates close to the esophagogastric junction, the surgical possibilities are limited and one treatment option is total gastrectomy with esophagojejunal anastomosis. We report a case series of four patients with chronic fistulae, who failed conservative treatment and required total gastrectomy. Their average length of hospital stay was 8.7 days (range, 5-15 days), without conversions, leaks, or other complications. In experienced hands, total gastrectomy is feasible by laparoscopic techniques and should be performed soon after the fistula is established.
authors.affiliation: The Department of Surgery, Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel, almogby@gmail.com.
authors.forename: Almog
authors.initials: A
authors.lastname: Ben Yaacov
authors.forename: Eran
authors.initials: E
authors.lastname: Sadot
authors.forename: Matan
authors.initials: M
authors.lastname: Ben David
authors.forename: Nir
authors.initials: N
authors.lastname: Wasserberg
authors.forename: Andrei
authors.initials: A
authors.lastname: Keidar
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D002908:Chronic Disease; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D007582:Jejunostomy; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome