fistula after gastric sleeve surgery

Question
I had gastric sleeve surgery in April 2010.  Immediately following surgery I developed a leak.  The Dr. went back in to repair it and immediately there was a leak.  I had one more surgery to repair leak and still have a leak.  i am on tube feeding and have a drain at the leak sight.  I have been through 8-10 scope procedures where the dr. has put clamps on and also used glue.  None of which have held.  It is now 10 months later and the leak has not repaired itself.  I am trying to decide my next move, and would appreciate any insight you might have as to my situation.

Answer
Donna,
The literature reports that a leak after Sleeve surgery can be VERY difficult to get healed.  Your brief description suggests that your surgeon has followed an appropriate series of corrective maneuvers even though they have not worked so far.

I can think of three options that may be appropriate at this stage, all of them depending on your particular surgical anatomy:

1)  Continue tube feeds, and wait for a really long time before trying any other intervention.  Gradually draw out the drain once things have healed down around it.  This is probably the best option, but requires patience.

2)  Variation on #1 - place a particular type of surgical tube called a T-tube directly into the leak/fistula.  Wait for several months for the tissue to heal in around the T-tube, then gradually draw out the tube and expect the fistula tract to close.

3)  Convert to a gastric bypass, removing the leak segment in the process of surgery.

My best wishes to you,
Dr JP

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