Laparoscopic bariatric surgery is the stand-alone treatment for morbid obesity. However, complications such as leak/fistula can be fearsome. Objectives: We aim to perform a systematic analysis of studies on intra-thoracic gastric fistula (ITGF) after bariatric surgery.
A comprehensive Pubmed/Medline search was conducted through March 2019 to retrieve papers describing management of ITGFs after a bariatric procedure.
A total of 25 studies were included comprising a total of 182 patients (80.62% female 19.37% male). Laparoscopic sleeve gastrectomy (LSG) was performed as the primary procedure in 84.6% of the patients followed by roux-en-y gastric bypass (RYGB) in 8.7%, vertical banded gastroplasty in 2.19%, laparoscopic adjustable gastric banding in 1.6%, and other procedures in 5 patients (2.6%). The gastro-bronchial fistula was the most common type of ITGF (31.31%) followed by gastro-pleural fistula (2.7%), gastro pulmonary fistula (7.1%), gastro pericardial fistula (1.64%), and gastro-colic and gastrosplenic fistula (each in 1 patient, 0.5%). The most common presenting symptoms included cough(43.75%), chest/abdominal pain (38.75%), and dyspnea (27.5%). Time to diagnosis ranged from 3 days to 156 months. Surgical resection (57.5%) and endoscopic closure (47.5%) were the most successful treatment modalities. Complete resolution was reported in 71.25% of the patients. Treatment failure occurred in 3 cases of gastro-bronchial, and 1 case of gastro-pulmonary and gastro-pericardial fistula. One case of death was reported in a patient with gastro-pulmonary fistula.
Timing of the fistula’s presentations has challenges to diagnosis and treatment. With a step-by-step approach, patients have a desirable outcome in the long-term follow-up.