Laparoscopic revision to total gastrectomy or fistulo-jejunostomy as a definitive surgical procedure for chronic gastric fistula after laparoscopic sleeve gastrectomy

Background: Staple-line leaks (SLL) after sleeve gastrectomy (SG) are a rare but serious complication requiring radiologic and endoscopic interventions with varying degrees of success. When failed, a chronic gastrocutaneous fistula forms with decreasing chances of closure with time. Definitive surgical management of chronic SLL after SG include laparoscopic revision to total/subtotal gastrectomy (LTG/LSTG) or a fistulo-jejunostomy (LRYFJ), both with Roux-en-Y reconstruction. Objectives: Comparison of SG revisions to LTG/LSTG versus LRYFJ as a definitive treatment for chronic SLL. Setting: High-volume bariatric unit. Methods: Retrospective review of a prospectively maintained database identified 17 patients with chronic gastric fistula after SG that were revised to either LTG/LSTG or LRYFJ between September 2011 and May 2020. Demographic characteristics, clinical data, quality of life, and laboratory values for both options were compared. Results: Of the 17 conversions, 8 were revised to LTG/LSTG and 9 to LRYFJ. Mean age and body mass index at revision were 36.85 years (range, 21–66 yr) and 29 kg/m² (range, 21–36 kg/m²), respectively. Average preoperative endoscopic attempts was 5 (range, 1–16). The overall average operation time of revision was 183 minutes (range, 130–275 min) with no significant difference between either conversion options. Mean follow-up time was 46.5 months (range, 1–81 mo) and was available for 10 patients (58.8%). Food intolerance was significantly better after revision to LRYFJ (n = 6/6, 100% versus n = 1/5, 20%, P <.05). There were no significant differences between revisional procedures and laboratory abnormalities. Conclusion: Laparoscopic revision to LRYFJ is a safe and feasible treatment for chronic SLL.