Al Hajj G, et al. - This study was undertaken to classify post-Laparoscopic sleeve gastrectomy (LSG) fistulas and propose an algorithm to optimize their treatment. Authors identified a radiologically defined, anatomically based classification system and treatment algorithm as effective in clinical management of post-LSG fistula.

Methods

• Following primary and revisional LSG in obese patients, authors undertook a retrospective observational study of fistulas.
• They performed radiological studies to assess anatomically distinct types of fistulas.
• They elaborated an algorithm for the classification and evolving treatment of each type of fistula.

Results

• Study of twenty post-LSG fistulas was performed (13 [2.5%] from authors' center, 7 referred); a mean body mass index was 43.1 ± 10.2 kg/m² (32.0–76.0) and mean age was 33.1 ± 11.4 years (20.0–56.0).
• In all cases, confirmation of the clinically suspected diagnosis was performed radiologically by water-soluble upper gastrointestinal series and double-contrast abdomino-pelvic CT scan.
• Authors characterized three anatomical fistula types: 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 accordance with this algorithm, conservative treatment was provided to patients without sepsis initially; this was sufficient for type I leaks.
• For type II abscesses, internal or external percutaneous drainage was performed, and in some cases, stenting or endoprosthesis were applied.
• They reserved surgery for failure of conservative options and type III fistula.
• Surgery was mandatory in cases of sepsis.