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Obesity Surgery
Published in: Obesity Surgery 8/2020

01-08-2020 | Endoscopy | Original Contributions

A French National Study on Gastropleural and Gastrobronchial Fistulas After Bariatric Surgery: the Impact of Therapeutic Strategy on Healing

Authors: L. Marie, M. Robert, L. Montana, F. De Dominicis, W. Ezzedine, R. Caiazzo, L. Fournel, A. Mancini, R. Kassir, S. Boullu, M. Barthet, X. B. D’Journo, Thierry Bège

Published in: Obesity Surgery | Issue 8/2020

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Abstract

Purpose

Gastropleural and gastrobronchial fistulas (GPF/GBFs) are serious but rare complications after bariatric surgery whose management is not consensual. The aim was to establish a cohort and evaluate different clinical presentations and therapeutic options.

Materials and Methods

A multicenter and retrospective study analyzing GPF/GBFs after bariatric surgery in France between 2007 and 2018, via a questionnaire sent to digestive and thoracic surgery departments.

Results

The study included 24 patients from 9 surgical departments after initial bariatric surgery (21 sleeve gastrectomies; 3 gastric bypass) for morbid obesity (mean BMI = 42 ± 8 kg/m2). The GPF/GBFs occurred, on average, 124 days after bariatric surgery, complicating an initial post-operative gastric fistula (POGF) in 66% of cases. Endoscopic digestive treatment was performed in 79% of cases (n = 19) associated in 25% of cases (n = 6) with thoracic endoscopy. Surgical treatment was performed in 83% of cases (n = 20): thoracic surgery (n = 5), digestive surgery (n = 8), and combined surgery (n = 7). No patient died. Overall morbidity was 42%. The overall success rate of the initial and secondary strategies was 58.5% and 90%, respectively. The average healing time was approximately 7 months. Patients who had undergone thoracic surgery (n = 12) had more initial management failures (n = 9/12) than patients who had not (n = 3/12), p = 0.001.

Conclusion

Complex and life-threatening fistulas that are revealed late require a multidisciplinary strategy. Thoracic surgery should be reserved once the abdominal leak heals; otherwise, it is associated with a higher risk of failure.
Literature
1.
Lazzati A, Audureau E, Hemery F, et al. Reduction in early mortality outcomes after bariatric surgery in France between 2007 and 2012: a nationwide study of 133,000 obese patients. Surgery. 2016;159(2):467–74.PubMedCrossRef
2.
3.
Vidarsson B, Sundbom M, Edholm D. Incidence and treatment of leak at the gastrojejunostomy in roux-en-Y gastric bypass: a cohort study of 40,844 patients. Surg Obes Relat Dis. 2019;15(7):1075–9.PubMedCrossRef
4.
Gagner M. Decreased incidence of leaks after sleeve gastrectomy and improved treatments. Surg Obes Relat Dis. 2014;10(4):611–2.PubMedCrossRef
5.
Rosenthal RJ. International Sleeve Gastrectomy Expert Panel, Diaz AA, Arvidsson D, Baker RS, Basso N, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases. Surg Obes Relat Dis. 2012;8(1):8–19.PubMedCrossRef
6.
Burgos AM, Braghetto I, Csendes A, et al. Gastric leak after laparoscopic-sleeve gastrectomy for obesity. Obes Surg. 2009;19(12):1672–7.PubMedCrossRef
7.
Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients. Surg Endosc. 2013;27(1):240–5.PubMedCrossRef
8.
van de Vrande S, Himpens J, El Mourad H, et al. Management of chronic proximal fistulas after sleeve gastrectomy by laparoscopic roux-limb placement. Surg Obes Relat Dis. 2013;9(6):856–61.PubMedCrossRef
9.
Silva LB, Moon RC, Teixeira AF, et al. Gastrobronchial fistula in sleeve gastrectomy and roux-en-Y gastric bypass--a systematic review. Obes Surg. 2015;25(10):1959–65.PubMedCrossRef
10.
Garcia-Quintero P, Hernandez-Murcia C, Romero R, et al. Gastropleural fistula after bariatric surgery: a report of two cases. J Robot Surg. 2015;9(2):163–6.PubMedCrossRef
11.
Bège T, Emungania O, Vitton V, et al. An endoscopic strategy for management of anastomotic complications from bariatric surgery: a prospective study. Gastrointest Endosc. 2011;73(2):238–44.PubMedCrossRef
12.
Gonzalez JM, Lorenzo D, Guilbaud T, et al. Internal endoscopic drainage as first line or second line treatment in case of postsleeve gastrectomy fistulas. Endosc Int Open. 2018;6(6):E745–50.PubMedPubMedCentralCrossRef
13.
Ghanem OM, Dayyeh BKA, Kellogg TA. Management of gastropleural fistula after revisional bariatric surgery: a hybrid laparoendoscopic approach. Obes Surg. 2017;27(10):2773–7.PubMedCrossRef
14.
Nedelcu AM, Skalli M, Deneve E, et al. Surgical management of chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):879–84.PubMedCrossRef
15.
Moeller DD, Carpenter PR. Gastrobronchial fistula: case report and review of the English literature. Am J Gastroenterol. 1985;80(7):538–41.PubMed
16.
Takeda S-I, Funaki S, Yumiba T, et al. Gastropleural fistula due to gastric perforation after lobectomy for lung cancer. Interact Cardiovasc Thorac Surg. 2005;4(5):420–2.PubMedCrossRef
17.
Muzaffar MS, Umair B, Asghar A, et al. Gastropleural fistula: an unusual sequel of blunt chest trauma. J Coll Physicians Surg Pak. 2009;19(7):447–9.PubMed
18.
Guillaud A, Moszkowicz D, Nedelcu M, et al. Gastrobronchial fistula: a serious complication of sleeve gastrectomy. Results of a French Multicentric Study. Obes Surg. 2015;25(12):2352–9.PubMedCrossRef
19.
Lorenzo D, Guilbaud T, Gonzalez JM, et al. Endoscopic treatment of fistulas after sleeve gastrectomy: a comparison of internal drainage versus closure. Gastrointest Endosc. 2018;87(2):429–37.PubMedCrossRef
20.
Seidelman RA, Seidelman J. Closure of gastro-pleuro-bronchial fistula with polymethyl methacrolate and endoclips: a rare complication of gastric bypass surgery. J Bronchology Interv Pulmonol. 2010;17(1):87–9.PubMedCrossRef
21.
Garrett KA, Rosati C. Gastro-broncho-pleural fistula after laparoscopic gastric band placement. Obes Surg. 2009;19(7):941–3.PubMedCrossRef
22.
Albanopoulos K, Tsamis D, Leandros E. Gastrobronchial fistula as a late complication of sleeve gastrectomy. Surg Obes Relat Dis. 2013;9(6):e97–9.
23.
Tabbara M, Polliand C, Barrat C. Gastrobronchial fistula: a rare complication of sleeve gastrectomy. J Visc Surg. 2015;152(6):395–6.PubMedCrossRef
24.
Rebibo L, Dhahri A, Berna P, et al. Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(3):460–7.PubMedCrossRef
25.
Bruzzi M, M’Harzi L, Poghosyan T, et al. Anatomical relations between the esogastric junction, the diaphragm, the pleura, and the left lung in chronic esogastro-bronchial and/or esogastropleural fistulas after sleeve gastrectomy. Obes Surg. 2019;29(9):2814–23.
26.
Yehoshua RT, Eidelman LA, Stein M, et al. Laparoscopic sleeve gastrectomy--volume and pressure assessment. Obes Surg. 2008;18(9):1083–8.PubMedCrossRef
27.
Marie L, Masson C, Gaborit B, et al. An experimental study of intraluminal hyperpressure reproducing a gastric leak following a sleeve gastrectomy. Obes Surg. 2019;29(9):2773–80.PubMedCrossRef
28.
Fuks D, Dumont F, Berna P, et al. Case report-complex management of a postoperative bronchogastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(2):261–4.PubMedCrossRef
29.
Aljehani Y, AlQattan AS, Alkuwaiti FA, et al. Thoracic complications of bariatric surgeries: overlooked entities. Obes Surg. 2019;29(8):2485–91.
30.
Alkhatib SG, Levine MS. Gastrobronchial fistula after sleeve gastrectomy: clinical and radiographic findings. Clin Imaging. 2019;53:112–4.PubMedCrossRef
31.
Van Gossum A, Pironi L, Chambrier C, et al. Home parenteral nutrition (HPN) in patients with post-bariatric surgery complications. Clin Nutr. 2017;36(5):1345–8.PubMedCrossRef
32.
Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 2011;21(10):1520–9.PubMedCrossRef
33.
Iannelli A, Tavana R, Martini F, et al. Laparoscopic roux limb placement over a fistula defect without mucosa-to-mucosa anastomosis: a modified technique for surgical management of chronic proximal fistulas after laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(5):825–8.PubMedCrossRef
34.
Ramos AC, Ramos MG, Campos JM, et al. Laparoscopic total gastrectomy as an alternative treatment to postsleeve chronic fistula. Surg Obes Relat Dis. 2015;11(3):552–6.PubMedCrossRef
35.
Bruzzi M, Douard R, Voron T, et al. Open total gastrectomy with roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(10):1803–8.PubMedCrossRef
36.
Landreneau JP, Strong AT, Rodriguez JH, et al. Conversion of sleeve gastrectomy to roux-en-Y gastric bypass. Obes Surg. 2018;28(12):3843–50.PubMedCrossRef
37.
Al-shurafa H, Alghamdi S, Albenmousa A, et al. Gastropleural fistula after single anastomosis gastric bypass. A case report and review of the literature. Int J Surg Case Rep. 2017;35:82–6.PubMedPubMedCentralCrossRef
Metadata
Title
A French National Study on Gastropleural and Gastrobronchial Fistulas After Bariatric Surgery: the Impact of Therapeutic Strategy on Healing
Authors
L. Marie
M. Robert
L. Montana
F. De Dominicis
W. Ezzedine
R. Caiazzo
L. Fournel
A. Mancini
R. Kassir
S. Boullu
M. Barthet
X. B. D’Journo
Thierry Bège
Publication date
01-08-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04655-5

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