Background

Gastric leak occurs in 1-6% of patients who undergo Roux-en Y gastric bypass (RYGB) for morbid obesity. The pathophysiology may be related to gastric ischemia, fistula, or ulcer.Gastric leak is a severe complication of gastric bypass (GBP) that is associated with significant morbidity and mortality. Fistula may have several clinical impacts, depending on patient-related factors, fistula characteristics, onset time, and therapy proposal. Abdominal drainage, gastrostomy, and revisional surgery constitute the traditional approaches to dehiscence and fistula closure, with variable results.

Methods

We present a video of a clinical case of 44-year-old lady with body mass index of 45Kg/m2 who underwent Roux-en-Y gastric bypass and 48 hours later presentedtaquicardia and right cuadrantum pain. The CTscan inform a apical leak at the gastric pouch level. The video shows the relevant aspects of a revisional surgery and the key points to drain the fistula and close the defect laparoscopically.

Results

After 6 months, the patient achieved successful results, defined as a stable clinical situation with image evidence of gastric fistula remision

Conclusions

Gastric bypass (GBP) is one of the most efficient bariatric interventions in morbidly obese patients. The most severe risk of this procedure seems to be the staple line leak, and the management of this complication can be very arduous. Without any guidelines it is very difficult to determine the right procedure addressing the staple line leak after GBP.