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Intrathoracic Gastric Fistula After Bariatric Surgery: A Systematic Review and Pooled Analysis Publisher Pubmed



Shoar S1 ; Hosseini FS2 ; Gulraiz A3 ; Ikram W4 ; Javed M4 ; Naderan M5 ; Shoar N6 ; Modukuru VR7
Authors
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Authors Affiliations
  1. 1. Department of Clinical Research, ScientificWriting Corp, Houston, TX, United States
  2. 2. Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Faculty of Medicine, Nishtar Medical University, Multan, Pakistan
  4. 4. Faculty of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
  5. 5. Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
  7. 7. Department of Surgery, Metropolitan Hospital Center, New York Medical College, New York, NY, United States

Source: Surgery for Obesity and Related Diseases Published:2021


Abstract

Even in the hands of highly experienced bariatric surgeons, perioperative complications are inevitable. Of these, leaks and fistulas are amongst the scariest complications. Intrathoracic gastric fistulas (ITGF) can be associated with serious morbidity, mostly when cases are misdiagnosed or detected with delay. This is a systematic review of the literature to investigate the clinical and surgical outcomes of morbidly obese adult patients with a confirmed diagnosis of ITGF following bariatric surgery. A pooled analysis of 25 articles, encompassing 76 patients with post-bariatric ITGF, showed that the clinical outcome depends on the initial presentation, timing of the diagnosis in relation to symptom onset, and prompt and effective treatment. Any septic or unstable patient must undergo urgent surgical intervention, while stable patients might tolerate a step-up approach and watchful waiting for nonsurgical treatment. Among those who undergo surgery, treatment failure and the mortality rate are substantially high. Contingent upon a prompt management strategy, patients with postbariatric ITGF can generally have a favorable outcome in the long term. © 2020 American Society for Bariatric Surgery
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