Gastric Fistula After Sleeve Gastrectomy: Clinical Features and Treatment Options

• Published in: Obesity surgery Vol. 31; no. 3; pp. 1196 - 1203
• Main Authors: Ferraz, Álvaro A. B., Feitosa, Pedro Henrique F., Santa-Cruz, Fernando, Aquino, Maria-Améllia R., Dompieri, Luca T., Santos, Eryka M., Siqueira, Luciana T., Kreimer, Flávio
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-03-2021; Springer Nature B.V
• Subjects: Adult; Anastomotic Leak - surgery; Endoscopy; Female; Fistula; Gastrectomy - adverse effects; Gastric Fistula - etiology; Gastric Fistula - surgery; Gastrointestinal surgery; Humans; Laparoscopy; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Original Contributions; Patients; Postoperative Complications - etiology; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Stents; Surgery; Treatment Outcome; Surgical complications; Fistula; Gastric leak; Endoscopic procedures; Bariatric surgery; Sleeve gastrectomy
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-020-05115-w

Purpose
To trace the clinical profile of fistula cases after sleeve gastrectomy (SG) and evaluate the efficacy and safety of endoscopic treatments and the admission costs of these patients.
Methods
This is a retrospective study of patients who developed gastric fistulas after SG. All patients were submitted to surgical and/or endoscopic interventions (self-expandable stent, septotomy, and balloon dilation). The main studied variables were need for reoperation, number of endoscopic procedures, endoscopic complications, time until fistula diagnosis, fistula location, time until resolution, length of hospital stay, and health costs.
Results
The sample was mainly female (76.2%) with a mean age of 39.5 years and a BMI of 39.6 kg/m
2
. In 90.5% of cases, the fistula occurred in the topography of the His angle. Thirteen patients required surgical intervention. Of the patients who underwent endoscopic interventions, it was necessary to place more than one self-expandable stent of a maximum duration of 4 weeks. Six patients underwent more than two sessions of septotomy. There was one case of bleeding after septotomy. Dilatation was required in 71.4% of patients and an average of two sessions (1–5) per patient. The diagnosis of fistula occurred 14.4 days after surgery. The average time to resolve fistulas was 50.6 days. The average hospital stay was 75.8 days. The total cost of hospitalization was on average US$ 75,180.00.
Conclusion
The surgical and endoscopic treatment of gastric fistulas after SG was safe and effective. There was a very low rate of complications. The time of onset of fistulas was not decisive for patient improvement.