title: Gastro-cutaneous fistula 4 years after a fully resolved staple line leak in sleeve gastrectomy.
abstract: Laparoscopic sleeve gastrectomy (LSG) has become a mainstream procedure in the management of obesity. Staple line leak is a challenging complication. We report a unique case of successfully treated leak after sleeve gastrectomy, presented ex novo 4 years later as a gastro-cutaneous fistula (GCF). Nothing similar was found in the literature. A 31-year-old woman underwent an LSG, complicated by an early type I leak treated successfully. After 4 years of clinical remission, the leak presented as a GCF. The conservative approach failed and a laparoscopic fistulectomy was first attempted, but after recurrence a completion gastrectomy was performed. A staple line leak is one of the most important complications after sleeve gastrectomy. Once chronic it evolves into GCF, the treatment of which is challenging. Given the absence of guidelines, experience is fundamental in its management. In our case, eventually a total gastrectomy was required.
authors.affiliation: Gastrointestinal Services, General Surgery, University College Hospital, London, UK dani83k@gmail.com.
authors.forename: Daniela
authors.initials: D
authors.lastname: Zanotti
authors.affiliation: Gastrointestinal Services, General Surgery, University College Hospital, London, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elkalaawy
authors.affiliation: Gastrointestinal Services, General Surgery, University College Hospital, London, UK.
authors.forename: Borzoueh
authors.initials: B
authors.lastname: Mohammadi
authors.affiliation: Gastrointestinal Services, General Surgery, University College Hospital, London, UK.
authors.forename: Majid
authors.initials: M
authors.lastname: Hashemi
authors.affiliation: Gastrointestinal Services, General Surgery, University College Hospital, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jenkinson
authors.affiliation: Gastrointestinal Services, General Surgery, University College Hospital, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Adamo