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10.12.2015 | Ausgabe 10/2016

Surgical Endoscopy 10/2016

Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results

Zeitschrift:
Surgical Endoscopy > Ausgabe 10/2016
Autoren:
Elie Chouillard, Antoine Younan, Mubarak Alkandari, Ronald Daher, Bernard Dejonghe, Salman Alsabah, Jean Biagini
Wichtige Hinweise
Presented at the SAGES 2015 Annual Meeting, April 15-18, 2015, Nashville, Tennessee.
On behalf of The Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), France.
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1007/​s00464-016-5102-8.

Abstract

Background

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.

Methods

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.

Results

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/m2 (22–41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections.

Conclusions

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.

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