Pylorus-preserving laparoscopic proximal gastric resection with Roux-en-Y esophagojejunostomy for late gastrocolic fistula after sleeve gastrectomy

Abstract

Laparoscopic sleeve gastrectomy (LSG) is among the most common metabolic bariatric procedures, but staple-line leak occurs in 1%–3% of cases and may evolve into chronic fistula. Gastrocolic fistula is rare and lacks standardized treatment. We describe a 44-year-old woman (body mass index 43 kg/m2) who developed a late staple-line leak 7 months after LSG that progressed to a gastrocolic fistula, with mega-stent-related pressure necrosis of the transverse colon as the proximate mechanism. After failed conservative and endoscopic management, laparoscopic revision was performed: adhesiolysis, proximal gastric resection, primary repair of the 4-cm colonic defect with omental patch, and Roux-en-Y esophagojejunostomy with anterior cruroplasty. The patient was discharged on postoperative day 15 and remained asymptomatic through 12 months, with intact anastomoses and no recurrence. Unlike previously reported proximal, near-total, or total gastrectomies, the distal antrum and pylorus were preserved. Laparoscopic revision is feasible and effective for this complex complication after LSG.