Primary Repair of Gastrobronchial Fistula Presenting 12 Years Post Uncomplicated Laparoscopic Sleeve Gastrectomy

Background: Obesity is an alarmingly increasing global public health issue. Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery owing to its simplicity, effectiveness, and low complication rates. The complications can be classified as early or late, with fistula formation being one of the most severe complications. Here, we report a rare gastrobronchial fistula (GBF) that presented 12 years post LSG.

Case Presentation: A 34-year-old woman who underwent LSG in 2011 was referred to our institution. The patient complained of recurrent upper respiratory tract infections, nausea, and vomiting. Abdominal computed tomography (CT) with oral contrast showed abnormal fistulous communication between the fundus and left lung. Conservative management was initiated but failed multiple times. After counseling the patient on the surgical options, she underwent fistula removal and primary repair of the fundus with a healthy omental wrap and an omental diaphragmatic flap. She tolerated the procedure well, recovered uneventfully, and was discharged on postoperative day 7.

Conclusion: GBF diagnosis is challenging. Imaging studies, such as CT and radiography with contrast and endoluminal diagnosis with esophagogastroduodenoscopy (EGD), bronchoscopy, and bronchial secretion analysis, aid in the diagnosis. GBF management requires a multidisciplinary team. Patients should be initially offered conservative management with the understanding that reoperation would be the only option if failure is seen for 3 months.