Laparoscopic sleeve gastrectomy (LSG) is a new restrictive bariatric procedure increasingly indicated in the treatment of morbid obesity. Postoperative complications are mainly represented by gastric fistula with an occurrence rate of 0% to 5.1% in the literature. This complication is difficult to manage and requires multiple radiological, endoscopic, and surgical procedures. We report herein the case of a 23-year-old woman who underwent LSG for morbid obesity. This patient was reoperated for peritonitis due to a gastric fistula located on the top of the staple line. Five months later, she complained of a cough with fever and expectoration. A methylene blue test and a computed tomography scan diagnosed a postoperative bronchogastric fistula. After failure of aggressive conservative management, radical surgery was performed with total gastrectomy, reconstruction of the diaphragm using the extended latissimus dorsi flap, and a pulmonary lobectomy. This case report highlights the possible issue of the complex management of gastric fistula after LSG.
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Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy—a prospective study in 135 patients with morbid obesity. Surgery. 2008; in pressGoogle Scholar
Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg 2008;18:560–565. [Epub ahead of print].CrossRefGoogle Scholar
Devbhandari MP, Jain R, Galloway S, et al. Benign gastro-bronchial fistula—an uncommon complication of esophagectomy: case report. BMC Surg 2005;5:16.CrossRefGoogle Scholar
Langer FB, Wenzl E, Prager G, et al. Management of postoperative esophageal leaks with the polyflex self-expanding covered plastic stent. Ann Thorac Surg 2005;79:398–403.CrossRefGoogle Scholar
Hünerbein M, Stroszczynski C, Moesta KT, Schlag PM. Treatment of thoracic anastomotic leaks after esophagectomy with self-expanding plastic stents. Ann Surg 2004;240:801–7.CrossRefGoogle Scholar
Schubert D, Scheidbach H, Kuhn R, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone covered, self-expanding polyester stents. Gastrointest Endosc 2005;61:897–900.CrossRefGoogle Scholar
Deitel M, Crosby RD, Gagner M. The First International Consensus Summit for Sleeve Gastrectomy (SG), New York City, October 25–27, 2007. Obes Surg 2008;18:487–496. [Epub ahead of print].CrossRefGoogle Scholar
Lee JH, Lee JY, Jang MK, et al. Bronchogastric fistula. Gastrointest Endosc 2005;61:289–90.CrossRefGoogle Scholar
Sakamoto K, Ogawa M, Yamamoto S, et al. Closure of gastric tube-tracheal fistula by transposition of a pedicled sternocleidomastoid muscle flap. Surg Today 1997;27:181–5.CrossRefGoogle Scholar
Aguilo Espases R, Lozano R, Navarro AC, et al. Gastrobronchial fistula and anastomotic esophagogastric stenosis after esophagectomy for esophageal carcinoma. J Thorac Cardiovasc Surg 2004;127:297–9.CrossRefGoogle Scholar
Brega Massone PP, Infante M, Valente M, et al. Gastrobronchial fistula repair followed by esophageal leak-rescue by transesophageal drainage of the pleural cavity. J Thorac Cardiovasc Surg 2002;50:113–6.CrossRefGoogle Scholar