Kermansaravi Mohammad, Shahabi Shahmiri Shahab, Teimoury Taher, Yarigholi Fahimeh, Sabooni Keyvan, Minakari Mohammad, Davarpanah Jazi Amir Hossein
Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Research Center, Hazrat‑E Fatemeh Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Fateme Hospital, Tehran, Iran.
Obes Surg. 2025 Aug 27. doi: 10.1007/s11695-025-08161-4.
Staple line leak is one of the most critical complications after metabolic and bariatric surgery (MBS). In chronic cases, definitive surgical reconstruction remains the treatment of choice. We report the case of a 24-year-old female with a history of sleeve gastrectomy (SG), converted to Roux-en-Y gastric bypass (RYGB) 2 days later due to a gastroesophageal junction (GEJ) leak. Postoperatively, she developed a left subdiaphragmatic collection requiring percutaneous drainage. One year later, due to recurrent symptoms, left subdiaphragmatic abscess and a fistulous tract between the collection and the gastric pouch on CT scan, surgical intervention was performed, including fistulojejunostomy using a new Roux-en-Y limb at the leak site. At 6-month follow-up, the patient remained without complication. The double Roux-en-Y (RY) configuration, involving the creation of an end-to-side RY fistulojejunostomy, can be an effective and feasible surgical option.
吻合口漏是代谢和减重手术后最严重的并发症之一。对于慢性病例，确定性手术重建仍是首选治疗方法。我们报告了一例24岁女性患者，该患者有袖状胃切除术（SG）病史，术后2天因胃食管交界（GEJ）漏而改行 Roux-en-Y 胃旁路术（RYGB）。术后，她出现左膈下积液，需要经皮引流。一年后，由于症状复发，CT扫描显示左膈下脓肿以及积液与胃囊之间存在瘘管，遂进行了手术干预，包括在漏口处使用新的 Roux-en-Y 肠袢行瘘管空肠吻合术。在6个月的随访中，患者未出现并发症。双 Roux-en-Y（RY）构型，即行端侧RY瘘管空肠吻合术，可能是一种有效且可行的手术选择。
