A Thoracoabdominal Approach for Gastrobronchial Fistula Repair Post Complicated Laparoscopic Sleeve Gastrectomy (LSG)

Abdullah Al Shammari

doi:10.21767/2471-8041.100083

Abstract

Laparoscopic sleeve gastrectomy (LSG) is a restrictive procedure without the malabsorptive component present in other bariatric procedures. It involves resection of twothirds of the stomach to provide increased satiety and decreased appetite. During the laparoscopic sleeve gastrectomy (LSG), about 75% of the stomach is removed leaving a narrow gastric “tube” or “sleeve”. No intestines are removed or bypassed during the sleeve gastrectomy. The LSG takes one to two hours to complete. A sleeve gastrectomy is a purely restrictive procedure. Here, we report the case of a 36-year-old woman who underwent a LSG procedure, complicated by a GBF that was managed through a thoracoabdominal approach.

Highlights

Laparoscopic sleeve gastrectomy (LSG) has become a popular validated bariatric procedure
Leaks can evolve into gastro-bronchial fistulas (GBF)
There is no consensus on the management of GBFs, which is further complicated by lack of sufficient literature [2]

Summary

Introduction

Laparoscopic sleeve gastrectomy (LSG) has become a popular validated bariatric procedure. The most common complication is gastric leak along the staple line in approximately 2 percent of LSG procedures [1]. There is no consensus on the management of GBFs, which is further complicated by lack of sufficient literature [2]. We report the case of a 36year-old woman who underwent a LSG procedure, complicated by a GBF that was managed through a thoracoabdominal approach. Patient underwent a left postero-lateral thoracotomy via the 7th intercostal space. The GBF passing through the posterior basal segment of left lung was visualized. A pus cavity containing food particles was identified between the posterior basal segment of left lung and the diaphragm. In the same setting of left postero-lateral thoracotomy, the abdominal cavity was accessed via medial diaphragmatic incision. Patient had an uneventful recovery following surgery, and was discharged home on day 16 postoperatively, at 18 months follow up, the patient is doing well, asymptomatic, with normal chest X-ray (Figure 3)

Findings

Discussion

Conclusion