Journal of Visceral Surgery (2014) 151, 411—412
Available online at
VISCERAL SURGERY VIDEOS
Laparoscopic surgical technique for gastric ﬁstula after sleeve gastrectomy with video E. Chapuis-Roux , L. Rebibo , A. Dhahri , J.-M. Regimbeau ∗ Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, CHU d’Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France Available online 7 October 2014
KEYWORDS Laparoscopic sleeve gastrectomy; Gastric ﬁstula
The sleeve gastrectomy is a validated bariatric surgical technique, effective for weight loss and correction of comorbidities associated with obesity. Currently, this is the most frequent surgical procedure performed in France for the management of morbidly obese patients. This procedure is associated with few postoperative complications, among which, the main is postoperative gastric ﬁstula observed in about 2% of cases [1,2]. This complication may be difﬁcult to be managed and often requires prolonged hospitalization duration with the need for one or several reoperations. In patients with early postoperative gastric ﬁstula (diagnosed within 7 postoperative days), a reoperation may be necessary using a laparoscopic approach if possible.
Figure 1. Video abstract of ‘‘Laparoscopic surgical technique for gastric ﬁstula after sleeve gastrectomy’’.
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http://dx.doi.org/10.1016/j.jviscsurg.2014.07.004 1878-7886/© 2014 Elsevier Masson SAS. All rights reserved.
412 We describe the case of a patient with early postoperative gastric ﬁstula appeared in the fourth postoperative day, well tolerated clinically. A reoperation was performed laparoscopically using the technique described by Rebibo et al. . This corresponds to an exploratory laparoscopy with bacteriological and yeast samples, washing of the peritoneal cavity with blue test to locate the digestive leak, suture of the ﬁstulous oriﬁce, establishment of a drainage module near to the ﬁstulous oriﬁce and implementation of a feeding jejunostomy. This video (Video 1, Fig. 1) clearly shows the different surgical steps and relevant points associated with this surgical procedure performed in emergency and sometimes by non-specialized surgeons.
Disclosure of interest The authors declare that they have no conﬂicts of interest concerning this article.
E. Chapuis-Roux et al.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/ 10.1016/j.jviscsurg.2014.07.004.
References  Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and metaanalysis of 9991 cases. Ann Surg 2013;257:231—7.  Fridman A, Moon R, Cozacov Y, et al. Procedure-related morbidity in bariatric surgery: a retrospective short- and mid-term follow-up of a single institution of the American College of Surgeons Bariatric Surgery Centers of Excellence. J Am Coll Surg 2013;217:614—20.  Rebibo L, Dhahri A, Verhaeghe P, Regimbeau JM. Early gastric ﬁstula after laparoscopic sleeve gastrectomy: surgical management. J Visc Surg 2012;149:e319—24.