ABSTRACT
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is an accepted restrictive procedure with a hormonal component. There is no definitive course of treatment for post-LSG fistula; it remains a feared complication. We aimed to classify post-LSG fistulas and propose an algorithm to optimize their treatment. METHODS: Following primary and revisional LSG in obese patients, a retrospective observational study of fistulas was undertaken. Radiological studies were performed to identify anatomically distinct types of fistulas. An algorithm was elaborated for the classification and evolving treatment of each type of fistula. RESULTS: Twenty post-LSG fistulas were studied (13 [2.5%] from our center, 7 referred) with a mean body mass index of 43.1 ± 10.2 kg/m2 (32.0-76.0) and mean age of 33.1 ± 11.4 years (20.0-56.0). In all cases, the clinically suspected diagnosis was radiologically confirmed by water-soluble upper gastrointestinal series and double-contrast abdomino-pelvic CT scan. Three anatomical fistula types were characterized: type I, a small leak with no collection; type II, a leak with associated intra-abdominal abscess; and type III, a leak with multiple internal or external abscesses, a complex fistula. In accord with our algorithm, patients without sepsis received conservative treatment initially; this was sufficient for type I leaks. Type II abscesses received internal or external percutaneous drainage, and in some cases, stenting or endoprosthesis. Surgery was reserved for failure of conservative options and type III fistula. In cases of sepsis, surgery was mandatory. CONCLUSION: A radiologically defined, anatomically based classification system and treatment algorithm proved effective in clinical management of post-LSG fistula.
Subject(s)
Algorithms , Digestive System Fistula/classification , Digestive System Fistula/etiology , Digestive System Fistula/therapy , Gastrectomy/adverse effects , Laparoscopy/adverse effects , Obesity, Morbid/surgery , Adolescent , Adult , Aged , Body Mass Index , Drainage , Female , Gastrectomy/methods , Humans , Laparoscopy/methods , Male , Middle Aged , Postoperative Complications/classification , Postoperative Complications/etiology , Postoperative Complications/therapy , Reoperation/methods , Retrospective Studies , Treatment Outcome , Young AdultSubject(s)
Digestive System Fistula , Drainage/methods , Skin Care/methods , Cutaneous Fistula/classification , Cutaneous Fistula/etiology , Cutaneous Fistula/therapy , Digestive System Fistula/classification , Digestive System Fistula/etiology , Digestive System Fistula/therapy , Drainage/nursing , Enterostomy , Humans , Patient Care Planning , Patient Education as Topic , Skin Care/nursingABSTRACT
Las fístulas digestivas constituyen cuadros clínicos de relativa frecuencia en la práctica quirúrgica. Tienen elevada morbi mortalidad; provocan angustia y cambios en la calidad de vida de los pacientes y preocupaciones en los cirujanos. Entre las fístulas digestivas, las hay de todos los segmentos(esofágicas, gastroduodenales, pancreáticas, biliares, intestinales y colónicas). En cuanto a sus causas las más frecuentes son postoperatorias. En esta revisión se presentan las clasificaciones de estas complicaciones mïas aceptadas en la actualidad. También se abordan los diversos eventos fisiopatplógicvos que tienen lugar en los diferntes tipos de fístulas digestivas así como las alernativas terapéuticas actualmente disponibles
