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Obesity Surgery

, Volume 29, Issue 9, pp 2814–2823 | Cite as

Anatomical Relations Between the Esogastric Junction, the Diaphragm, the Pleura, and the Left Lung in Chronic Esogastro-bronchial and/or Esogastro-pleural Fistulas After Sleeve Gastrectomy

  • Matthieu BruzziEmail author
  • Leïla M’Harzi
  • Tigran Poghosyan
  • Salma El Batti
  • Franck Zinzindohoué
  • Jean-Marc Chevallier
  • Richard Douard
Original Contributions

Abstract

Purpose

Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG.

Methods

Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017.

Results

A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula’s termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage.

Conclusions

Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.

Keywords

Sleeve gastrectomy Gastro-bronchial fistula Gastro-pleural fistula Bariatric surgery 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Considerations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.URDIA Anatomie (EA4465)Paris Descartes Faculty of MedicineParisFrance
  2. 2.INSERM 970, Équipe 2PARCC, HEGPParisFrance
  3. 3.General and Digestive Surgery Unit, Georges PompidouAP-HP University HospitalParis Cedex 15France
  4. 4.Paris Descartes Faculty of MedicineParisFrance

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