Wiki Takedown gastric fistula, Roux-en-Y fistula jejunostomy, & dx lap


Escondido, CA
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Preoperative Dx: Gastric fistula S/P sleeve gastrectomy

Procedure: Takedown of gastric fistula, Roux-en-Y fistula jejunostomy, & dx lap

Fistula was below the angle of his. The was a tremendous amount of scarring & due to that & inflammatory tissue in this are, & dissection could not be done safely laparoscopically. Trocars were removed & procedure was performed open. Inferior edge of the sleeve along greater curvature side was dissected free. Stomach was freed. Fistula was id'd. Roux-en-Y fistula jejunostomy was determined to be the best course. Jejunum was anastomosed to the biliary limb in a sid-to-side fashion using the Endo stapler. Enterotomies were closed - inner & outer layer. Mesenteric defect was closed. Roux limb was brought through transverse mesocolon in a retrocolic fashion in antigastric. a side-to-side anastomosis was performed in 2 layers. A nasogastric tube was passed into the Roux limb. Roux limb was tacked to the transverse mesocolon closing this defect using interrupted sutures. Drains were passed through the trocar site, one placed in the subhepatic region, the other placed along the site of the anastomosis in the LT subdiaphragmatic region.