title: Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is an increasingly popular bariatric procedure. A chronic fistula at the esophago-gastric junction (EGJ) is a rare but life-threatening complication of this procedure whose causes are still unclear and management is still controversial.
  
  
  METHODS
  A 41-year-old woman with a body mass index (BMI) of 38 developed an EGJ leak 6 days post-LSG. Despite initial control with conservative measures, the leak persisted and resulted in a left pleural abscess and a broncho-pleural fistula requiring thoracotomy with resection of the abscessed lung parenchyma. Endoscopic and drainage procedures failed to prevent subdiaphragmatic recurring collection due to the persistent fistula. Nineteen months after LSG, a Roux limb was placed on the EGJ and sutured side to side around the fistula defect, without mucosa-to-mucosa anastomosis.
  
  
  RESULTS
  The postoperative course was uneventful and, 20 months later (39 months post-LSG), the patient is well with a BMI of 27.
  
  
  CONCLUSIONS
  Laparoscopic apposition of a Roux-en-Y limb without mucosa-to-mucosa anastomosis as an efferent path to drain the undebrided fistula defect can effectively treat chronic leaks at the EGJ after LSG.
authors.affiliation: Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint-Antoine de Ginestière, BP 3079, Nice, Cedex 3, France, antonio_iannelli@hotmail.com.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
authors.forename: Reza
authors.initials: R
authors.lastname: Tavana
authors.forename: Francesco
authors.initials: F
authors.lastname: Martini
authors.forename: Patrick
authors.initials: P
authors.lastname: Noel
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
mesh_terms: D000328:Adult; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D004322:Drainage; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009767:Obesity, Morbid / Q000601:surgery*; D010995:Pleural Diseases / Q000209:etiology / Q000601:surgery*; D011013:Pneumonectomy; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome