Background

46-year-old female with past medical history of diabetes, hypertension, anemia, GERD, and obesity with a BMI of 31 had laparoscopic sleeve gastrectomy at an outside hospital, complicated by staple line leak. This was treated with stents and endo-clips, and then ultimately a drain by interventional radiology. She presented to our institution months later with reflux, and the drain in place. Preoperatively an upper GI study revealed no obvious stricture, no pooling of contrast near the catheter, but there was a contour deformity at the gastric cardia. An esophagogastroduodenoscopy demonstrated a fistula where the pigtail catheter eroded into the gastric wall with a stricture at the incisura angularis. The patient was scheduled to undergo a revision of the sleeve gastrectomy. Due to the previous leak and erosion of the catheter, a significant portion of the sleeve was compromised. The decision was made to perform a total gastrectomy and proceed with an esophagojejunostomy reconfiguration. The stomach was resected, small bowel was run 150 cm distal from the ligament of Treitz to be utilized for the Roux limb, then a jejunojejunostomy anastomosis was created 150 cm distal to the small bowel transection. Both anastomoses were closed with white staple loads while the esophagojejunostomy was created with a blue load, and the common enterotomy was closed with a suture. The hiatus was then closed with silk sutures, and a blake drain was placed posterior to the EJ anastomosis. The drain was removed at 2-week visit, patient progressed on her diet and denies reflux symptoms.