Updated: May 7
Yesterday a 24 year old patient who was referred to me with this devastating complication of a sleeve gastrectomy was finally discharged after 7 months in hospital and several complex interventions.
The fistula followed a leak from a sleeve gastrectomy for weight loss in February 2020 and she was transferred to my care in London in October 2020 after failure of conservative treatment and with multi-resistant organisms due to the prolonged use of antibiotics. A thorough assessment including bronchoscopy showed a large cavity associated with a 1 cm defect in the gastric sleeve fistulating into the peripheral left lower lobe bronchi.
She required multiple staged interventions and operations including a temporary tube oesophagostomy and left lower lobectomy, ending with the removal of the gastric sleeve and a Roux-en-Y oesophago-jejunal anastomosis. She finally left hospital eating a normal diet without coughing every time she ate. This was the culmination of a huge effort by a large team of colleagues including other surgeons, dieticians, physiotherapists and ITU staff.
I have dealt with many complications of oesophageal and gastric surgery but this was one of the most challenging cases I have treated. So many crossroads where difficult judgement calls were required, when faced with several different management options. As with many complex cases, the surgery may be difficult but it is the timing and the choice of the operation that makes the greatest difference to outcome.