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Laparoscopic Roux En Y Esophago-Jejunostomy for Chronic Leak/Fistula After Laparoscopic Sleeve Gastrectomy.

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  • Additional Information
    • Source:
      Publisher: Springer Science + Business Media Country of Publication: United States NLM ID: 9106714 Publication Model: Print Cited Medium: Internet ISSN: 1708-0428 (Electronic) Linking ISSN: 09608923 NLM ISO Abbreviation: Obes Surg Subsets: MEDLINE
    • Publication Information:
      Publication: 2006- : New York : Springer Science + Business Media
      Original Publication: Oxford, OX, UK : Rapid Communications of Oxford, [1991-
    • Subject Terms:
      Anastomosis, Roux-en-Y/*methods ; Fistula/*surgery ; Gastrectomy/*adverse effects ; Jejunostomy/*methods ; Laparoscopy/*methods ; Obesity, Morbid/*surgery; Adult ; Esophagus/surgery ; Fistula/etiology ; Gastrectomy/methods ; Humans ; Jejunum/surgery ; Middle Aged ; Prospective Studies ; Reoperation/methods ; Treatment Outcome ; Young Adult
    • Abstract:
      Background: Leak following laparoscopic sleeve gastrectomy (LSG) is one of the most serious and devastating complications. Endoscopic stents can treat most early LSG leaks, but is not as effective for chronic LSG leaks/fistulae. The surgical options to treat a chronic leak/fistula after LSG are laparoscopic Roux en Y esophago-jejunostomy (LRYEJ) or laparoscopic Roux en Y fistulo-jejunostomy.
      Methods: We reviewed our prospective database for all patients with leak after LSG treated with LRYEJ. We have described our algorithm for managing LSG previously. We prefer to optimize the nutritional status of patients with enteral rather than parenteral nutrition and drain all collections prior to LRYEJ.
      Results: We have treated four patients utilizing our technique of LRYEJ. Initial endoscopic stent placement was attempted in all four patients (two failed to resolve (50 %) and two had distal stenosis at the incisura not amenable to endoscopic stenting). We utilized enteral feeding through either naso-jejunal (NJ) or jejunostomy tube feeding in 3/4 (75 %) of patients, and in one patient with stenosis, we could not introduce a NJ tube endoscopically due to tight stricture. This patient was placed on total parenteral nutrition (TPN) and went on to develop pulmonary embolism. None of the patient developed leak after LRYEJ. The only patient with stenosis (25 %) had antecolic LRYEJ. In contrast, all patients who had retrocolic LRYGB laparoscopically did not develop stenosis.
      Conclusions: Laparoscopic Roux en Y esophago-jejunostomy for chronic leak/fistula after is safe and effective. Preoperative enteral nutrition is important.
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    • Contributed Indexing:
      Keywords: Chronic leak/fistula laparoscopic Roux en Y esophago-jejunostomy; Laparoscopic sleeve gastrectomy; Morbid obesity
    • Publication Date:
      Date Created: 20160106 Date Completed: 20161020 Latest Revision: 20181202
    • Publication Date:
      20240628
    • Accession Number:
      10.1007/s11695-015-2018-7
    • Accession Number:
      26729280