Multidisciplinary management with endoscopic internal drain of gastric sleeve leak (in Spanish)

Abstract

INTRODUCTION. The number of obese patients has increased exponentially during the last three decades, according to the 2016 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) survey, gastric sleeve occupies 53.6% of bariatric procedures performed worldwide. Gastric fistula is one of the complications presented in this type of procedure, with a prevalence of between 0.5 and 7%. CASE REPORT. 46-year-old female patient, who entered the Bariatric Surgery protocol, with morbid obesity due to a Body Mass Index (BMI) of 45.2 kg / m2 plus dyslipidemia and an excess weight of 54 kg , presented as an early complication of gastric fistula, the fistula was identified in the upper third of the staple line with abdominal sepsis that was treated with revisional surgery with peritoneal cavity lavage and drains placement. RESULTS: Endoscopic management was performed with esophageal endoprosthesis that migrated twice, requiring the removal and subsequent placement of a nasojejunal tube plus internal drainage (pigtail) through the continuity solution. At 39 days after revision surgery, he was discharged with a leak closure with a BMI of 36 kg / m2 and normal nutritional parameters. DISCUSION. Gastric sleeve fistulas or leaks have closure without surgical correction depending on the series of up to 97.1%. Endoscopic management presents satisfactory results through the use of an internal drainage catheter "pig tail". CONCLUSION. The systematic multidisciplinary management for an early gastric fistula with enteral nutrition by means of a nasojejunal catheter plus endoscopic pigtail placement was favorable and is one of the available strategies for resolution of this complication, being the first reported in Ecuador.