Abstract Background Staple-line leak is the most common postoperative complication of laparoscopic sleeve gastrectomy (LSG). Although its incidence has decreased in recent years, the management of chronic leaks remains challenging. In some patients, treatment failure necessitates more aggressive interventions to permanently resolve the issue. Case presentation A patient was admitted with a gastrocutaneous fistula 2.5 years after undergoing LSG. A staple-line leak had occurred on postoperative day 2. Based on available information, a diagnostic laparoscopy was performed at the time. Endoscopic treatments were also attempted but were unsuccessful. After 26 months, a second laparoscopy was conducted. Endoscopic evaluation revealed a fistula opening at the gastroesophageal junction and a stenosis at the incisura angularis. Upon admission, we performed another laparoscopy and identified the fistula tract. The orifice was located at the gastroesophageal junction. The patient underwent Roux-en-Y fistulojejunostomy (RYFJ). Dissection of fibrotic adhesions and identification of the fistula orifice in the upper part of the gastric tube were the most challenging aspects of the procedure. The postoperative course was uneventful. Oral feeding was initiated on the second postoperative day, and the patient was discharged on postoperative day 5. Thirty months later, the patient was readmitted due to a left diaphragmatic hernia and underwent emergency surgery. A 4-cm defect was identified in the left hemidiaphragm. Most of the small intestine and the splenic flexure of the colon had herniated into the thoracic cavity. Primary repair and dual mesh fixation were performed. The postoperative course was uneventful, and the patient was discharged three days later. Five years after the initial surgery, the patient was readmitted again due to weight regain. Endoscopy and contrast imaging revealed a dilated stomach and a nearly closed fistula orifice. We performed a Roux-en-Y gastrojejunostomy, resected the gastric remnant, and recreated the anastomosis using a stapler. A gastric leak after LSG is considered chronic if it persists beyond 12 weeks, and surgical management is generally warranted after the failure of adequate endoscopic, radiologic, and nutritional therapies. Chronic fistulas tend to be associated with more complications compared to acute ones. Conclusion Laparoscopic Roux-en-Y fistulojejunostomy (LRYFJ)appears to be an effective salvage option for selected patients with chronic gastric leaks following LSG. However, it remains a technically demanding procedure and should be performed in experienced bariatric centres by skilled bariatric surgeons.
Altun et al. (Thu,) studied this question.