Bencivenga M,Giacopuzzi S,Matteo Zenzaro,Zigiotto D,
Gastrobronchial Fistula After Re-Sleeve Gastrectomy: Case Report and Review of Literature
Global Surgery Case Reports
2019
2733-2535
http://dx.doi.org/10.31487/j.GSCR.2019.01.01
https://www.sciencerepository.org/gastrobronchial-fistula-after-re-sleeve-gastrectomy-case-report-and-review-of-literature_GSCR-2019-1-101 
Abstract: Introduction: Gastro-bronchial fistula (GBF) is a rare and challenging complication of sleeve gastrectomy
as it is the result of a chronic gastric leak and subsequent long-standing sub-phrenic abscess. In this article
we report the first case of GBF after a re-sleeve gastrectomy.
Case Presentation: a 42-years-old patient was admitted to our Unit because of the arise of sepsis,
hypothension and cough with expectoration of enteral nutrition. The patient had a history of sleeve (2010)
and re-sleeve gastrectomy (2017) for weight regain. On admission radiological signs of consolidation of the
left pulmonary lobe and, after the swallowing of oral contrast, a little backward trans-diaphragmatic
opacification of the main bronchus was described. An open total gastrectomy with a trans-abdominal
atypical lower pulmonary lobe resection were performed. A post-operative ERAS protocol was adopted,
and the patient was discharged in POD 9 in good conditions, after an uneventful recovery and feeding per
os.
Conclusions: To our knowledge this is the first case of a GBF after a re-sleeve gastrectomy, more evidences
are needed before routinely advice a re-sleeve gastrectomy after a failed sleeve gastrectomy. Indeed, given
that in revisional bariatric surgery the risk of gastric leak may be higher due to a greater tension applied on
the staple line, the incidence of rare but serious complications such GBF may consequently increase.Keywords: Gastrobronchial fistula, gastropulmonary fistula, sleeve gastrectomy, re-sleeve gastrectomy, total gastrectomy, case report