title: Roux-En-Y Fistulo-Jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula.
abstract: BACKGROUND
  Sleeve gastrectomy (SG) is currently the most common bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction of comorbidities. However, leak is still the most common complication after SG. Nevertheless, its risk of occurrence is <3% in specialized centers. Its management is difficult, long, and challenging. Although the procedure is commonly endoscopic and nonoperative, the management of post-SG fistulas could sometimes be surgical, including peritoneal lavage, abscess drainage, disrupted staple line suturing, resleeve, gastric bypass, or total gastrectomy. Roux-en-Y fistulojejunostomy (RYFJ) has been described as a salvage option. In this study, we report the early results of RYFJ for post-SG fistula, emphasizing indications, operative technique, and short-term outcome.
  
  
  METHODS
  Between January 2007 and December 2012, we treated 62 patients with post-SG fistula. Before surgery, intra-abdominal or thoracic abscesses or collections were either excluded or treated by computed tomographic scan-guided drainage or even surgery. Endoscopic stenting was then attempted. After optimization of the nutritional status in case of failure of endoscopic measures, some of the patients underwent RYFJ.
  
  
  RESULTS
  Between January 2007 and December 2012, a total of 21 patients (16 women and 5 men) had RYFJ for post-SG fistula. Mean age was 47 years (range, 22-59 years). Procedures were performed laparoscopically in all but 3 cases. The rate of secondary conversion to laparotomy was 11.1%. The was no mortality. The postoperative morbidity rate was less than 5%. The rate of fistula control was eventually 100%.
  
  
  CONCLUSIONS
  RYFJ is a safe and feasible salvage procedure for the treatment of patients with post-SG fistula. Longer outcome analysis is, however, needed especially regarding the physiological and metabolic behavior of the procedure.
authors.affiliation: Division of Bariatric Surgery, Department of Surgery, Poissy/Saint-Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France, chouillard@yahoo.com.
authors.forename: Elie
authors.initials: E
authors.lastname: Chouillard
authors.forename: Elias
authors.initials: E
authors.lastname: Chahine
authors.forename: Naim
authors.initials: N
authors.lastname: Schoucair
authors.forename: Antoine
authors.initials: A
authors.lastname: Younan
authors.forename: Mohammad Al
authors.initials: MA
authors.lastname: Jarallah
authors.forename: Alain
authors.initials: A
authors.lastname: Fajardy
authors.forename: René-Louis
authors.initials: RL
authors.lastname: Vitte
authors.forename: Jean
authors.initials: J
authors.lastname: Biagini
mesh_terms: D000328:Adult; D000465:Algorithms; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery; D050110:Bariatric Surgery / Q000009:adverse effects*; D004322:Drainage; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015607:Stents; D017792:Surgical Stapling / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult