Management of Gastropleural Fistula after Revisional Bariatric Surgery: A Hybrid Laparoendoscopic Approach

Introduction: Gastropleural fistula (GPF) is a serious complication after bariatric surgery. Multiple treatment modalities including pharmacologic, endoscopic, and revisional surgery have been proposed. We present a case of a GPF managed successfully with a laparoendoscopic approach utilizing a fistula plug. Methods: A 43-year-old male patient presented with a GPF after a revisional bariatric surgery. A laparoendoscopic approach including lysis of adhesions, identification of the fistula, plugging the fistula with a BioGore A® fistula plug, placement an enteric stent, placement of a feeding tube, and surgical drainage was performed. The multimedia video illustrates the technique used. Results: Postoperatively, upper gastrointestinal (UGI) imaging showed no evidence of leak. The enteric stent was removed after 2 months after verifying complete healing of the fistula. Conclusion: A laparoendoscopic approach to GPF repair with the use of fistula plug is effective, safe, and feasible.