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Obesity Surgery
Published in: Obesity Surgery 10/2017

01-10-2017 | Video Submission

Management of Gastropleural Fistula after Revisional Bariatric Surgery: A Hybrid Laparoendoscopic Approach

Authors: Omar M. Ghanem, Barham K. Abu Dayyeh, Todd A. Kellogg

Published in: Obesity Surgery | Issue 10/2017

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Abstract

Introduction

Gastropleural fistula (GPF) is a serious complication after bariatric surgery. Multiple treatment modalities including pharmacologic, endoscopic, and revisional surgery have been proposed. We present a case of a GPF managed successfully with a laparoendoscopic approach utilizing a fistula plug.

Methods

A 43-year-old male patient presented with a GPF after a revisional bariatric surgery. A laparoendoscopic approach including lysis of adhesions, identification of the fistula, plugging the fistula with a BioGore A® fistula plug, placement an enteric stent, placement of a feeding tube, and surgical drainage was performed. The multimedia video illustrates the technique used.

Results

Postoperatively, upper gastrointestinal (UGI) imaging showed no evidence of leak. The enteric stent was removed after 2 months after verifying complete healing of the fistula.

Conclusion

A laparoendoscopic approach to GPF repair with the use of fistula plug is effective, safe, and feasible.
Appendix
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Literature
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Rebibo L, Dhahri, Berna P, et al. Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 10(3):460–467.
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Fuks D, Dumont F, Berna P, et al. Case report—complex management of a postoperative bronchogastric fistula after laparoscopic sleeve gastrectomy. Obes Surg. 19(2):261–264.
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Luo RB, Liu S, DeLong JC, et al. Laparoscopic gastropleural fistula repair: a minimally invasive solution for a complex problem. J Laparoendosc Adv Surg Tech.
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Campos JM, Siqueira LT, Ferraz ÁA, et al. Gastrobronchial fistula after obesity surgery. J Am Coll Surg. 204(4):711.
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Pequignot A, Fuks D, Verhaeghe P, et al. Is there a place for pigtail drains in the management of gastric leaks after laparoscopic sleeve gastrectomy?. Obes Surg. 22(5):712–720.
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Campos JM, Pereira EF, Evangelista LF, et al. Gastrobronchial fistula after sleeve gastrectomy and gastric bypass: endoscopic management and prevention. Obes Surg. 21(10):1520–1529.
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Metadata
Title
Management of Gastropleural Fistula after Revisional Bariatric Surgery: A Hybrid Laparoendoscopic Approach
Authors
Omar M. Ghanem
Barham K. Abu Dayyeh
Todd A. Kellogg
Publication date
01-10-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-017-2836-x

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