title: Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy.
abstract: BACKGROUND
  Surgery appears to be the best treatment option for a chronic fistula after laparoscopic sleeve gastrectomy (LSG). Conservative procedures (conversion into a Roux-en-Y gastric bypass, Roux-limb placement) have proven their feasibility and efficacy, but an open total gastrectomy (TG) is sometimes required in challenging situations.
  
  
  OBJECTIVE
  To assess outcomes from 12 consecutive patients who underwent surgery for a post-sleeve gastrectomy chronic fistula (PSGCF) between January 2004 and February 2012.
  
  
  METHODS
  University public hospital, France.
  
  
  METHODS
  Patients with a PSGCF who underwent surgery were included in this retrospective study. Mortality, morbidity (i.e., Clavien-Dindo score), weight loss, and nutritional status were assessed.
  
  
  RESULTS
  Twelve of 57 patients (21%) with a post-LSG leak developed a PSGCF. There were 3 men (25%). Mean age was 39±9 years and mean preoperative body mass index was 35±5 kg/m2. All 12 patients underwent an open total gastrectomy with an esojejunostomy (TG). Conservative procedures were considered but not possible. The mean follow-up period was 38±11 months. The mean delay between LSG and TG was 12±6 months. Intraoperative discovery of multiple (>2) gastric fistulas was reported in 9 patients (75%). There were no deaths, but morbidity rate was 50%. Early postoperative fistula occurred in 3 patients (anastomosis n = 1, duodenal stump n = 2). None of these patients required further surgery. The median healing time of the fistula was 37 days (range 24-53). Promising results from weight loss and nutritional status were found at the end of the follow-up.
  
  
  CONCLUSIONS
  A salvage open TG is a well-tolerated and reproducible salvage procedure for cases of a PSGCF, when conservative procedures are not possible.
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges-Pompidou, Paris, France. Electronic address: matthieu_bruz@yahoo.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Bruzzi
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Douard
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Voron
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Zinzindohoue
authors.affiliation: Department of Digestive Surgery, Hôpital Européen Georges-Pompidou, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chevallier
mesh_terms: D000208:Acute Disease; D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D002908:Chronic Disease; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D005773:Gastroscopy / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Chronic fistula; Gastric leakage; Morbid obesity; Sleeve gastrectomy; Total gastrectomy