Bariatric/Metabolic Surgery Fistula: Diagnosis and Treatment Options
Posted in Lectures on 16 August 2018
Kelvin D. Higa, MD, FACS, FASMBS
Clinical Professor in Surgery, UCSF
Director Bariatric and Minimally Invasive Surgery
Fresno Heart and Surgical Hospital
Over the past two decades, bariatric surgery has become the most effective available treatment for morbid obesity and metabolic syndrome. According to recents publications, the two most commonly performed bariatric operations worldwide are the laparoscopic roux-en-Y gastric bypass and the laparoscopic sleeve gastrectomy.
Despite the accumulation of vast collective experience by the community of bariatric surgeons, a constant challenge facing these surgeons remains the management of the complications of these operations. The primary major complication reported after a laparoscopic roux-en-Y gastric bypass and a laparoscopic sleeve gastrectomy is leakage, which may appear early or late during the postoperative period. Its management requires a complex, multidisciplinary approach. Treatment modalities generally include various combinations of conservative management, percutaneous drainage, endoscopic interventions, and operative solutions. However, there is no single universal solution for this often hard to manage complication.
In this lecture, Kelvin D. Higa presents different cases of patients undergoing bariatric surgery who have presented with a complication such a fistula throughout its postoperative period and gives a brief summary of the best treatment in each case, how these types of complications should be treated, and the mechanisms available to avoid them.