• Imed Ben Amor, Panagiotis Lainas, Radwan Kassir, Jean Hubert Etienne, Vincent Casanova, Ibrahim Dagher, and Jean Gugenheim.
• Department of Digestive Surgery, Archet II Hospital, Nice, France.
• Obes Surg. 2020 Jan 1; 30 (1): 378-380.

BackgroundAs laparoscopic sleeve gastrectomy (LSG) is becoming the most popular bariatric procedure worldwide, treatment options for managing complications, in particular gastric leaks, are also emerging. Staple line leak is a major short-term complication of the procedure. Patients with persistent gastric leaks after failure of endoscopic and radiologic management are candidates for salvage surgery. Laparoscopic Roux-en-Y fistulo-jejunostomy (RYFJ) represents a surgical option to treat persistent gastric leak post-LSG.MethodsWe present the case of a 55-year-old woman undergoing laparoscopic double RYFJ for persistent gastric leaks after complicated bariatric surgery. The patient developed two chronic gastric leaks (gastro-esophageal and cardial localizations) following conversion to sleeve gastrectomy for failed vertical banded gastroplasty. With the two leaks being refractory to endoscopic treatment 6 months later after laparoscopic sleeve gastrectomy, salvage surgery was proposed. Surgery was performed laparoscopically, the gastric leak orifices were identified after careful dissection, and a double RYFJ was successfully completed.ResultsPostoperative course was uneventful. The patient remains in good health 6 months after surgery.ConclusionsDouble LRYFJ for chronic leaks after complicated bariatric procedures seems safe with good postoperative outcomes. However, it remains a challenging procedure and should be reserved for selected patients in specialized bariatric centers.

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