Hybrid management with graham patch repair assisted with an OVESCO endoscopic system for a post-Nissen fundoplication gastric fistula: A case report.

INTRODUCTION AND IMPORTANCE: Gastric fistula is a complication in gastrointestinal surgery. For decades, patients with gastric fistulas were treated surgically, with high morbidity and mortality. Minimally invasive treatment through endoscopic therapy with stents and interventionism has allowed improvements. We present a case of successful hybrid laparoscopy and endoscopy for the treatment of a post-Nissen fundoplication gastric fistula. CASE PRESENTATION: A 44-year-old male underwent laparoscopic Nissen fundoplication surgery; at 10 days post-surgery, he presented with oral intolerance, abdominal pain, and laboratory results showing an inflammatory response. Imaging studies indicated intra-abdominal collection; therefore, a laparoscopy revision was performed; transoperative endoscopy confirmed intra-abdominal collection and a gastric fistula. In turn, we performed closure with an omentum patch through the fistula fixed with OVESCO by endoscopy, with successful results. CLINICAL DISCUSSION: Gastric fistula is a difficult complication to treat because exposure to secretions causes inflammation. Endoscopic techniques are described for the closure of gastrointestinal fistulas; however, several aspects must be considered for their use. Hybrid laparoscopic and endoscopic treatment in the same surgery can be useful and served as a novel and successful option in our case. CONCLUSION: Hybrid treatment with endoscopy and laparoscopy can be considered an optional approach for the management of gastric fistulas greater than 1 cm and of several days of evolution.

Bowel obstruction due to the migration of the deflated intragastric balloon, a rare and potentially lethal complication.

Obesity is a worldwide epidemic that carries significant morbidity and mortality. There are many weight loss strategies available, yet to this date, none are risk-free. Intragastric balloons have been used for decades as a temporary measure for weight reduction and can be a useful approach for specific patients. Serious complications related to the device remain rare; however, prompt intervention is usually needed when they arise. We present the case of a 38-year-old female patient, she was using an intragastric balloon to treat her obesity. Regretfully, the balloon deflated causing intestinal migration and obstruction. After a successful surgery, the patient completely recovered.