Successful treatment of gastrobronchial fistula following laparoscopic sleeve gastrectomy: A case report and review of literature.

BACKGROUND: Gastrobronchial fistula (GBF) is a rare but severe complication after sleeve gastrectomy (SG). GBF is associated with significant morbidity and mortality. Diagnosis is often delayed due to nonspecific symptoms. Therefore, timely recognition and management are critical. Endoscopic management, as the cornerstone of initial therapy, can be performed in a combined or stepwise manner for chronic or refractory cases.

CASE SUMMARY: A 48-year-old male with class II obesity and metabolic syndrome underwent laparoscopic SG. Six months later, he developed poor oral intake, chest pain, and dyspnea. Chest radiography and computed tomography revealed massive left pleural effusion, and laboratory tests showed leukocytosis. Video-assisted thoracoscopic surgery and esophagogastroduodenoscopy revealed a fistulous tract between the sleeved stomach and pleural cavity. Management included decortication, nasoduodenal feeding, and multiple sessions of endoscopic vacuum therapy. Although the fistula orifice decreased in size, an upper gastrointestinal series performed during follow-up indicated progression to GBF. We repeated decortication and placed a covered self-expandable metallic stent. Six weeks later, the stent was removed. Esophagogastroduodenoscopy confirmed that the GBF successfully healed.

CONCLUSION: Early suspicion, prompt diagnosis, and adequate intervention of GBF are crucial when the complication arises after laparoscopic SG. Endoscopic approaches, such as endoscopic vacuum therapy and stenting, are effective first-line therapies.