Laparoscopic Roux-En-Y Fistulo-Jejunostomy, a Preferred Technique after Failure of Endoscopic and Radiologic Management of Fistula Post Sleeve Gastrectomy

Background: Laparoscopic sleeve gastrectomy represents the most performed bariatric procedure in France. Staple line leak is the major short-term complication of the procedure. Patients with persistent fistula after sleeve gastrectomy, after failure of endoscopic and radiological treatment, are candidates for salvage surgery. Laparoscopic fistulo-jejunostomy (LRYFJ) represents a surgical option to treat persistent fistula post sleeve. Methods: The case of a 46-year-old woman, with persistent fistula after sleeve gastrectomy, undergoing laparoscopic fistula-jejunostomy is presented. The patient developed an abdominal abscess 2 months after sleeve gastrectomy, treated with radiological drainage. Upper gastrointestinal endoscopy was performed for pigtail insertion. Three months later, the fistula was persistent and salvage surgery was proposed. At surgery, the pigtail drain and the fistula orifice were identified with careful dissection. Then a manual Roux-en-Y fistula-jejunal anastomosis and a mechanical jejuno-jejunal anastomosis are performed. Results: The postoperative course was uneventful. Conclusions: LRYFJ for chronic fistula after sleeve gastrectomy is safe and effective. However, it remains a challenging procedure and should be reserved for specialized centers.