James Taggart, MD, Rebecca Kowalski, MD, Jonathan Wong, MD, Julio Teixeira, MD. Lenox Hill Hospital
Background: Gastric leak after a sleeve gastrectomy is an uncommon complication, but can lead to significant morbidity and mortality. A rare but devastating complication is a gastropleural fistula. The management of fistulas in bariatric surgery with endoscopic stents is well described in the literature, but often the only option left for the patient is reoperation. Robotic surgery with superior visualization and instrument manipulation, is a new platform that offers advantages to tackling these difficult reoperations.
Case summary: We present the case of a 62-year-old man who underwent a laparoscopic gastric band and subsequent conversion a laparoscopic sleeve gastrectomy two years later for band migration and weight gain. The sleeve gastrectomy was complicated by a leak and the patient was treated successfully with an endoscopic covered stent. Two years after the sleeve gastrectomy the patient presented with pneumonia and was found to have a gastropleural fistula. Due to the persistent and chronic leak, he was taken to the operating room for a planned conversion of the sleeve gastrectomy to a robotic-assisted Roux-En-Y gastric bypass and resection of the gastropleural fistula.
Conclusions: Complications after bariatric surgery can have delayed presentation and long term morbidity. This case presents a gastropleurofistula as a delayed complication following a leak from a sleeve gastrectomy, and the use of robotic surgery for difficult reoperations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79354
Program Number: V094
Presentation Session: Bariatric Video Session
Presentation Type: Video