Gastrobronchial fistula as a complication of bariatric surgery: A series of 6 cases

Objective: To present a multicenter series of 6 patients who developed gastrobronchial fistula (GBF). GBF is a rare subtype of gastric leaks following bariatric surgery, which is the mainstay of treatment for the obesity pandemic. Methods: We retrospectively identified 6 patients with GBF (out of 2,308 cases performed: 0.2%). One patient had undergone Roux-en-Y gastric bypass, and 5 had a sleeve gastrectomy. Demographics, previous surgeries, clinical presentation, timing of fistula diagnosis, diagnostic and treatment measures employed, and outcome were collected. Results: Four patients were female, the average age and BMI were 42 years and 42.5 kg/m², respectively. Three patients had previous surgeries (Nissen fundoplication, adjustable gastric banding, and vertical banded gastroplasty). Median time to fistula diagnosis was 40 days (range 15-90 days). Clinical presentation included chronic cough, hemoptysis, dyspnea and fever as well as persistent left pleural effusion or pneumonia. Diagnosis was confirmed by computed tomography in all cases. Two patients were treated nonoperatively, while 4 eventually required surgery for resolution. Left lower lobectomy was necessary in 3 of 4 cases. Concomitant procedures were total gastrectomy in 2 cases and conversion of a sleeve to a gastric bypass in 1 case. Resolution occurred 30 days to 2 years after initial surgery. No mortalities were encountered. Conclusions: GBF is a rare but devastating complication following bariatric surgery. It may develop as a late complication of a chronic upper gastric leak. Surgery is curative although nonoperative management may be warranted in selected cases.