Ben Nun Alon, Simansky David, Rokah Merav, Zeitlin Nona, Golan Nir, Abu Khalil Ramez, Soudack Michalle
Department of General Thoracic Surgery, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Department of General Thoracic Surgery, Sheba Medical Center, Ramat Gan, Israel.
World J Surg. 2018 Jun;42(6):1792-1797. doi: 10.1007/s00268-017-4358-z.
Laparoscopic sleeve gastrectomy is a common surgical management of morbid obesity. Major complication rate is 3-8%. Staple line leak is one of the most serious complications. In a small group of patients, a gastro-pulmonary fistula is formed. Endoscopic and minimally invasive measures are the first line of treatment with considerable success rate. There are very poor data in the literature what should be done in cases of failure. In this paper, we report our positive experience with definitive surgical repair.
Retrospective evaluation of 13 consecutive patients referred to the general thoracic surgery department for gastro-pulmonary fistula following sleeve gastrectomy.
Prior to their referral, all patients underwent surgical or percutaneous drainage and multiple treatment attempts including stent insertion, pyloric dilatation, endo-clip/ring closure, endoscopic argon ablation and glue injection. Two patients underwent emergency thoracotomy for sepsis and bile empyema. One died in the early postoperative period. Eleven patients underwent semi-elective definitive surgery. Surgery included left lower lobectomy, partial diaphragmectomy and digestive system reconstruction. There was no mortality or major complications in this group. Complication rate was 45% mostly local wound infection and pneumonia.
Gastro-pulmonary fistula is a rare devastating complication of sleeve gastrectomy. When minimally invasive measures fail, there is no place for nihilism. Surgical repair is possible and safe. The data presented herein support this treatment policy.
腹腔镜袖状胃切除术是治疗病态肥胖的常见手术方式。主要并发症发生率为3% - 8%。吻合口漏是最严重的并发症之一。在一小部分患者中，会形成胃-肺瘘。内镜和微创措施是一线治疗方法，成功率较高。文献中关于治疗失败时应采取何种措施的数据非常匮乏。在本文中，我们报告了我们在确定性手术修复方面的积极经验。
对连续13例因袖状胃切除术后发生胃-肺瘘而转诊至胸外科的患者进行回顾性评估。
在转诊之前，所有患者均接受了手术或经皮引流以及多次治疗尝试，包括支架置入、幽门扩张、内镜夹/环闭合、内镜氩气消融和胶水注射。2例患者因脓毒症和胆汁性脓胸接受了急诊开胸手术。1例在术后早期死亡。11例患者接受了半择期确定性手术。手术包括左下肺叶切除术、部分膈肌切除术和消化系统重建。该组无死亡或重大并发症。并发症发生率为45%，主要是局部伤口感染和肺炎。
胃-肺瘘是袖状胃切除术罕见但极具破坏性的并发症。当微创措施失败时，不应采取虚无主义态度。手术修复是可行且安全的。本文所提供的数据支持这一治疗策略。
