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 (R) 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.