title: Persistent gastric fistula after sleeve gastrectomy: an analysis of the time between discovery and reoperation.
abstract: BACKGROUND
  Gastric leak (GL) represents one of the main early-onset postoperative complication of sleeve gastrectomy (SG). Most studies of GL featured short series and no data on the time to reoperation for persistent GL.
  
  
  OBJECTIVE
  Characterize the time between discovery of persistent post-SG GL and the implementation of reoperation.
  
  
  METHODS
  University hospital, France, public practice.
  
  
  METHODS
  All patients treated for post-SG GL between November 2004 and December 2013 were included. The primary efficacy criterion was the time interval between discovery of a persistent GL and reoperation. The secondary efficacy criteria were demographic, surgical, and endoscopic data; mortality rate; time to GL healing; treatment success rate; and risk factors for failure treatment.
  
  
  RESULTS
  Eighty-six patients were treated for post-SG GL. Forty patients (46.5%) had early-onset GL (postoperative day ≤ 7). Two patients (2.3%) presented primary gastrobronchial fistula. Fifty-six patients (70%) underwent immediate reoperation. Endoscopic treatment was required to treat the GL in 92.7% of the cases (n = 77). The mortality rate was 1.2% (n = 1). The treatment success rate was 89.1%. The median time to healing GL was 84 days (14-423 d). Eighty percent of the GLs had healed 120 days after discovery. After 120 days, the incidence of complications related to GL increased and few additional GLs healed. The only identified risk factor for treatment failure was large retained gastric fundus (P ≤ .05).
  
  
  CONCLUSIONS
  Most cases of GL can be adequately treated by incorporating endoscopic stenting. Surgery for persistent GL should be performed within 120 days of discovery; after this cut-off, the incidence of GL-related complications increases. Large retained gastric fundus is a risk factor for treatment failure and may prompt the surgeon to consider earlier reoperation.
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Rebibo
authors.affiliation: Department of Gastroenterology, Amiens University Hospital, Amiens, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bartoli
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
authors.forename: Abdennaceur
authors.initials: A
authors.lastname: Dhahri
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Cosse
authors.affiliation: Department of Radiology, Amiens University Hospital, Amiens, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Robert
authors.affiliation: Department of Gastroenterology, Amiens University Hospital, Amiens, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Brazier
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Pequignot
authors.affiliation: Department of Gastroenterology, Amiens University Hospital, Amiens, France.
authors.forename: Sami
authors.initials: S
authors.lastname: Hakim
authors.affiliation: Department of Radiology, Amiens University Hospital, Amiens, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Yzet
authors.affiliation: Department of Gastroenterology, Amiens University Hospital, Amiens, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Delcenserie
authors.affiliation: Department of Medical and Surgical Intensive Care Unit, Amiens University Hospital, Amiens, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France. Electronic address: regimbeau.jean-marc@chu-amiens.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D005743:Gastrectomy / Q000009:adverse effects*; D005747:Gastric Fistula / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Double pigtail stent; Gastric covered stent; Gastric leak; Persistent gastric leak; Roux-en-Y gastrojejunal anastomosis; Sleeve gastrectomy