Sleeve Gastrectomy Complicated by Chronic Gastrocutaneous Fistula, Septic emboli to the Brain and pulmonary embolism

Fernando Safdie, MD, Pablo Marin, MD, Carolina Ampudia, MD, Abraham Betancourt, MD, Emanuele Lo Menzo, MD, Samuel Szomstein, MD, Raul Rosenthal, MD

The Bariatric and Metabolic Institute and the Section of Minimally Invasive and Endoscopic Surgery, Cleveland Clinic Florida

Introduction: Gastrointestinal leaks after bariatric surgery are the primary cause of serious morbidity and mortality nationwide. Enteric leaks can differ in severity, presentation, and management.

Materials and Methods: 45Y Female, S/P laparoscopic sleeve gastrectomy in 2008 with revision in 2012 at an outside facility, complicated by leak, abscess, requiring drainage and esophageal stent.
A six trocars laparoscopic approach was chosen. Extensive sharp and blunt adhesiolysis performed. The fibrosed right crus was carefully dissected. At the GE junction a cavity was identified an entered. Large amounts of pus and saliva were drained. Her distal esophagus and stomach were transected with the linear stapler, and an antecolic esophagojejunostomy was performed in a side-to-side fashion. Intraoperative leak test was done with air-methylene blue. A tube gastrostomy was placed into the distal stomach. Drains were left in the subhepatic space

Results: The postoperative course was complicated by new intraabdominal collections that required IR drainage and C. Diff colitis which was medically treated. Ultimately she was weaned off TPN, resume on diet and sent home with a PICC line for long term IV Antibiotics

Conclusion: Most leaks are successfully managed nonoperatively. Nonetheless revisions still play a role in chronic leaks and gastrocutaneous fistula resection. These are technically challenging procedures and should be only performed by experienced surgeons

Session: Video ChannelDay 2

Program Number: V095

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