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Fistula following laparoscopic sleeve gastrectomy: A proposed classification and algorithm for optimal management

Obesity Surgery Sep 08, 2017

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.


  • 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.


  • 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.

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