Staple line leaks (SLL) following sleeve gastrectomy (SG) are a rare but serious complication requiring radiologic and endoscopic interventions with varying degrees of success. When failed, a chronic gastro-cutaneous fistula forms with decreasing chances of closure with time. Definitive surgical management of chronic SLL following SG include laparoscopic revision to total/subtotal gastrectomy (LTG / LTSG ( or a fistulo-jejunostomy (LRYFJ), both with Roux-en-Y reconstruction.
High volume bariatric unit.
Describe our experience and comparison of SG revisions to LTG/LTSG or LRYFJ as a definitive treatment for SLL.
Retrospective review of a prospectively maintained database identified 17 patients with chronic gastric fistula following SG that were revised to either LTG/LSTG or LRYFJ between September 2011 and May 2020. Demographics, clinical data, quality of life and laboratory values for both options were compared.
Of the 17 conversions, 8 were revised to LTG/LSTG and 9 to LRYFJ. Mean age and BMI at revision were 36.85 (range 21-66) and 29 (range 21-36), respectively. Average pre-operative endoscopic attempts was 5 (range 1-16). The overall average operation time of revision was 183 minutes (range 130-275 minutes) with no significant difference between either conversion options. Mean follow up time was 46.5 months (range 1-81) and was available for 10 patients (58.8%). Food intolerance was significantly better following revision to LRYFJ (n=6/6, 100% vs n=1/5, 20%, p<0.05). There were no significant differences between revisional procedures and laboratory abnormalities.
Laparoscopic revision to LRYFJ is a safe and feasible treatment for chronic SLL