Journal of Visceral Surgery (2014) 151, 411—412
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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’’.
∗
Corresponding author. Tel.: +33 3 22 66 79 28; fax: +33 3 22 66 00 86. E-mail address: [email protected] (J.-M. Regimbeau).
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. [3]. 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 [1] 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. [2] 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. [3] Rebibo L, Dhahri A, Verhaeghe P, Regimbeau JM. Early gastric fistula after laparoscopic sleeve gastrectomy: surgical management. J Visc Surg 2012;149:e319—24.
Available online at
ScienceDirect www.sciencedirect.com
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’’.
∗
Corresponding author. Tel.: +33 3 22 66 79 28; fax: +33 3 22 66 00 86. E-mail address: [email protected] (J.-M. Regimbeau).
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. [3]. 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 [1] 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. [2] 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. [3] Rebibo L, Dhahri A, Verhaeghe P, Regimbeau JM. Early gastric fistula after laparoscopic sleeve gastrectomy: surgical management. J Visc Surg 2012;149:e319—24.
