Background

The patient is a 58-year-old with past medical hx of HTN, T2DM, DV/PE, CHF and a sleeve gastrectomy in 2018 that was complicated by recurrent episodes of contained left upper quadrant perforations, leaks, and abscesses adjacent to the proximal staple line. The patient had multiple Emergency Department presentations and admissions requiring bowel rest, IV antibiotics and Total Parenteral Nutrition. Most recently she was admitted to our institution and underwent an esophagogastroduodenoscopy, which showed a proximal gastric fistula 36 cm from incisors with some pustular drainage. The patient was managed with prolonged post-pyloric tube feeds and nothing by mouth to improve nutrition while allowing the tissue to heal in anticipation of surgical intervention. She underwent a Roux-en-Y Gastric Fistula-Jejunostomy as a revision for her chronic staple line leaks and infections. The procedure is presented and described as shown in the attached video. Post-operatively, the patient did well without any immediate complications. She underwent an upper GI study that did not show a leak. She reported no ongoing abdominal pain in her one-month post-op follow up while tolerating a full liquid diet.