An innovative endoscopic management strategy for postoperative fistula after laparoscopic sleeve gastrectomy

Background Postoperative fistula is a life-threatening complication that lacks a standard treatment strategy after laparoscopic sleeve gastrectomy (LSG). This observational study is the first to report the efficacy and safety of endoscopic full-thickness resection (EFTR) combined with purse-string sutures in treating this complication. Patients and methods The old fistula was resected by EFTR, cut radially, and then sutured with a purse-string. The primary endpoint was complete fistula closure within two months. Endoscopic procedure-related complications were also recorded. Results Eight of 788 LSG patients developed fistulas with an incidence of 1.01%, primarily under the gastroesophageal junction, and the average distance from the center of the fistula to the cardia was 30 +/- 6.3 mm. Two patients were cured by conservative treatment, and six received endoscopic sutures. The time from LSG to fistula diagnosis was 12.3 +/- 14.4 days. The time from fistula diagnosis to endoscopic repair was 43.8 +/- 55.8 days and 21.4 +/- 10.0 days after eliminating the data of first case. The average fistula size was 12 +/- 10 mm, the average endoscopic procedure duration was 40 +/- 16 min, and the average number of endoscopic procedures required was 1.6 +/- 0.8. Five patients achieved the primary endpoint, and one patient refused a third endoscopic suture after two sutures. The endoscopy success rate was 83.3%. No endoscopic procedure-related complications occurred. Conclusions EFTR combined with purse-string sutures is an innovative, safe, and effective endoscopic strategy for postoperative fistula after LSG, avoiding reoperation and allowing early oral feeding.

Automated summary

This observational study reports the efficacy and safety of endoscopic full-thickness resection combined with purse-string sutures in treating postoperative fistula after laparoscopic sleeve gastrectomy. The results showed that this innovative endoscopic strategy is safe, effective, and allows early oral feeding.