Laparoscopic Roux-en-Y Fistulo-Jejunostomy (RYFJ) for Post Sleeve Gastrectomy Fistula

Salman K Al-Sabah, MD, MBA, FRCSC, FACS1, Elie Chouillard, PhD, MD2. 1Al-Amiri Hospital Kuwait, 2Poissy-Saint-Germain-En-Laye Medical Center

Sleeve gastrectomy is a commonly used procedure in morbid obesity. However, leak is still the most common complication after sleeve gastrectomy and its management is difficult, long and challenging. Roux-En-Y Fistulo-Jejunostomy has been described as a salvage option. This video illustrates Roux-En-Y Fistulo-Jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula. We present two patients with fistula who failed non-operative management including endoscopic stents. The technique was demonstrated on two patients; after primary sleeve gastrectomy and after revisional gastric band to sleeve followed by resleeve for failed weight loss. We illustrate the use of V-Lock sutures to aid in doing such high fistulas. We conclude that Roux-En-Y Fistulo-Jejunostomy is a safe and feasible salvage procedure for the treatment of patients with post-sleeve gastrectomy fistulas. However the exact metabolic profile is yet to be defined.

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