title: Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results.
abstract: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713-723. doi: 10.1016/j.soard.2014.01.016 , 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954-1960 doi: 10.1007/s00464-014-3424-y , 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome.
  
  
  
  Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series.
  
  
  
  Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22-59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18-90). Mean body mass index (BMI) was 27.4 kg/m(2) (22-41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections.
  
  
  
  Despite the lack of long-term follow-up, RYFJ could be a safe and feasible salvage option for the treatment of patients with post-SG fistula, especially those who failed conservative management. Mid-term outcome analysis confirms that fistula control is durable. Weight loss panel is satisfactory.
authors.affiliation: Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France. chouillard@yahoo.com.
authors.forename: Elie
authors.initials: E
authors.lastname: Chouillard
authors.affiliation: Department of General Surgery, Bellevue Medical Center, Beirut, Lebanon.
authors.forename: Antoine
authors.initials: A
authors.lastname: Younan
authors.affiliation: Department of General Surgery, AlSabah Hospital, Kuwait City, Kuwait.
authors.forename: Mubarak
authors.initials: M
authors.lastname: Alkandari
authors.affiliation: Department of General and Minimally Invasive Surgery, Paris Poissy Medical Center, Poissy, France.
authors.forename: Ronald
authors.initials: R
authors.lastname: Daher
authors.affiliation: Unit of Medical Nutrition, Paris Poissy Medical Center, Poissy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Dejonghe
authors.affiliation: Department of General Surgery, Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Salman
authors.initials: S
authors.lastname: Alsabah
authors.affiliation: Department of General and Bariatric Surgery, Saint-Joseph Hospital, Beirut, Lebanon.
authors.forename: Jean
authors.initials: J
authors.lastname: Biagini
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D050110:Bariatric Surgery; D015897:Comorbidity; D005260:Female; D005602:France; D005743:Gastrectomy; D005747:Gastric Fistula / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bariatric; Fistula; Gastrectomy; Laparoscopy; Leak; Obesity; Sleeve