title: Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects.
abstract: OBJECTIVE
  To describe the technical aspects of a laparoscopic Roux limb placement for the management of chronic proximal fistulas after laparoscopic sleeve gastrectomy (LSG). Laparoscopic Roux limb placement has been proposed as corrective strategy after LSG proximal leak.
  
  
  METHODS
  A retrospective chart and database review was conducted in our institution. From January 1, 2002 to May 30, 2013, 18 patients underwent a laparoscopic Roux limb placement on the defect for the treatment of a proximal chronic fistula. The aim of this article was to present the operative technique.
  
  
  RESULTS
  Eighteen patients who underwent laparoscopic Roux limb placement had undergone previous treatments including percutaneous drainage, endoscopic stenting of the fistula, and even percutaneous glue treatment. These patients had a chronic fistula and were admitted for a Roux limb placement of the fistula. The mean time for a chronic fistula to heal alter Roux limb placement was 13.5 ± 10.3 days, and the mean length of hospital stay was 18.4 ± 13.2.
  
  
  CONCLUSIONS
  Proximal leaks after LSG are relatively rare. However, a significant number become chronic. Laparoscopic placement of a Roux limb on the defect is a safe treatment. An accurate surgical technique should be done.
authors.affiliation: Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium, vilallongapuy@hotmail.com.
authors.forename: Ramon
authors.initials: R
authors.lastname: Vilallonga
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.forename: Simon
authors.initials: S
authors.lastname: van de Vrande
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D002908:Chronic Disease; D004322:Drainage / Q000379:methods; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome