Julietta Chang, MD, Andrew Strong, MD, Maitham Moslim, MD, Mena Boules, MD, Kevin El-Hayek, MD, Jeffrey Ponsky, MD, John Rodriguez, MD, Matthew Kroh, MD. Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic
Introduction: Anastomotic or staple-line leak remains a devastating complication following bariatric surgery. Though uncommon, intrathoracic complications following leak include a spectrum of disease ranging from relatively minor, such as sympathetic pleural effusions, to fistulous connections between the gastrointestinal tract to thoracic structures such as the pleural space, airways, and cardiac structures. These can result in devastating sequelae that often require multiple interventions for treatment.
Methods: We performed a retrospective chart review of patients with intrathoracic complications after bariatric surgery who were treated at our institution.
Results: We identified 9 patients with severe intrathoracic complications including 5 after laparoscopic sleeve gastrectomy, 2 after Roux-en-Y gastric bypass, 1 after vertical banded gastroplasty, and 1 after laparoscopic gastric plication. Severe intrathoracic complications included 4 esophageal or gastric fistulas to the pleural space; 3 fistulas to the pericardial space; and 1 fistula to the airway. All 5 pleural fistulas were to the left pleural space; 3 of 5 pleural fistulas required decortication and wedge resection or lobectomy in addition to tube drainage of the pleural space, and 4 of 5 patients required partial or completion gastrectomy with Roux-en-Y gastro- or esophagojejunostomy. All 3 patients with pericardial fistulas required completion gastrectomy with transhiatal esophagectomy and cervical esophagostomy. The one esophagobronchial fistula required a conversion of her sleeve gastrectomy to a completion gastrectomy with Roux-en-Y esophagojejunostomy as well as a lobectomy for control of her sepsis. All patients had eventual resolution of their thoracic complications with multidisciplinary therapy. There were no 30 day mortalities in our series.
Conclusions: Severe intrathoracic complications following bariatric surgery are sequelae of anastomotic or staple line leaks and manifest as fistulas to various cavities or organs which guides their management. These are morbid complications which often require multiple interventions across a spectrum of specialties for control of the fistulous connection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79373
Program Number: P374
Presentation Session: Poster (Non CME)
Presentation Type: Poster