title: Gastrobronchial Fistula: A Serious Complication of Sleeve Gastrectomy. Results of a French Multicentric Study.
abstract: BACKGROUND
  Gastrobronchial fistula (GBF) is a complication of esophageal, splenic, or antireflux surgeries and was recently described as a complication of bariatric surgery. Our aim was to study all cases of GBF after laparoscopic sleeve gastrectomy (LSG) managed in five French university bariatric centers in order to establish the incidence and to evaluate the different treatments of this complication.
  
  
  METHODS
  We retrospectively studied 13 patients which developed GBF after LSG performed between March 2007 and August 2012. Patients were separated into two groups: patients who had early gastric fistula which has evolved into a GBF (group 1) and patients who had a late gastric fistula, either directly GBF or a late gastric fistula evolved in GBF (group 2).
  
  
  RESULTS
  Group 1 consisted of five patients and group 2 of eight patients. All patients were undernourished at diagnosis. Management of GBF was a combined thoraco-abdominal surgery with gastrojejunal anastomosis (n = 5) or total gastrectomy (n = 1), multiple endoscopic treatment and thoracic surgery (n = 3), an endobronchial valve (n = 1), total gastrectomy and thoracic drainage (n = 1), and transorificial intubation with thoracic surgery or drainage (n = 2). There was no mortality. All GBF healed.
  
  
  CONCLUSIONS
  GBF after LSG is a serious complication which is not anecdotal. Most of the early gastric fistulas occuring after LSG become chronic and can evolve into a GBF. Surgical approach is an effective treatment. Endobronchial valve is a novel alternative.
authors.affiliation: Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Guillaud
authors.affiliation: Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, University Paris 5, Hôpital Européen Georges Pompidou, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Moszkowicz
authors.affiliation: Department of Surgery, Saint Eloi Hospital-CHRU Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier Cedex 5, France.
authors.forename: Marius
authors.initials: M
authors.lastname: Nedelcu
authors.affiliation: Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Caballero-Caballero
authors.affiliation: Department of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France.
authors.forename: Fabian
authors.initials: F
authors.lastname: Reche
authors.affiliation: Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France.
authors.forename: Julio
authors.initials: J
authors.lastname: Abba
authors.affiliation: Department of Digestive Surgery-Pôle digi-DUNE-University Joseph Fourier (UJF), CHU Grenoble, CS 10217, 38043, Grenoble Cedex 09, France. CArvieux@chu-grenoble.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Arvieux
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D001983:Bronchial Fistula / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005602:France / Q000453:epidemiology; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005747:Gastric Fistula / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bariatric surgery; Gastrobronchial fistula; Gastropulmonary fistula; Obesity; Sleeve gastrectomy