Laparoscopic Roux limb placement for the management of chronic proximal fistulas after sleeve gastrectomy: technical aspects
- 442 Downloads
To describe the technical aspects of a laparoscopic Roux limb placement for the management of chronic proximal fistulas after laparoscopic sleeve gastrectomy (LSG).
Summary background data
Laparoscopic Roux limb placement has been proposed as corrective strategy after LSG proximal leak.
A retrospective chart and database review was conducted in our institution. From January 1, 2002 to May 30, 2013, 18 patients underwent a laparoscopic Roux limb placement on the defect for the treatment of a proximal chronic fistula. The aim of this article was to present the operative technique.
Eighteen patients who underwent laparoscopic Roux limb placement had undergone previous treatments including percutaneous drainage, endoscopic stenting of the fistula, and even percutaneous glue treatment. These patients had a chronic fistula and were admitted for a Roux limb placement of the fistula. The mean time for a chronic fistula to heal alter Roux limb placement was 13.5 ± 10.3 days, and the mean length of hospital stay was 18.4 ± 13.2.
Proximal leaks after LSG are relatively rare. However, a significant number become chronic. Laparoscopic placement of a Roux limb on the defect is a safe treatment. An accurate surgical technique should be done.
KeywordsSleeve gastrectomy Complication Leak Roux limb Treatment
Dr. Ramon Vilallonga and Dr. van de Vrande have no conflicts of interest. Dr. Jacques Himpens is a consultant for Ethicon Endosurgery and organizes workshops for Gore.
Supplementary material 1 (M4V 39985 kb)
- 3.Carrodeguas L, Szomstein S, Soto F, Whipple O, Simpfendorfer C, Gonzalvo JP et al (2005) Management of gastrogastric fistulas after divided Roux-en-Y gastric bypass surgery for morbid obesity: analysis of 1,292 consecutive patients and review of literature. Surg Obes Relat Dis 1:467–474PubMedCrossRefGoogle Scholar
- 6.Iannelli A, Tavana R, Martini F, Noel P, Gugenheim J (2014) 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 24:825–828PubMedCrossRefGoogle Scholar