Background

We present a laparoscopic Roux-en-Y- fistulojejunostomy for the treatment of an esophageal perforation after Nissen sleeve gastrectomyThis 37-year-old patient suffering from obesity and gastro esophageal reflux disease (GERD) underwent a Nissen sleeve gastrectomy. Several episodes of vomiting occurred post-operatively. At 8 days post-op, she developed sepsis, leading to the discovery of an esophageal fistula.Conservative treatment was first initiated, including antiobiotherapy, parenteral nutrition, and endoscopic treatment. The evolution at 21 days post-op was unfavorable with the occurrence of multivisceral deficiency and a peri splenic absess. Emergency surgical management was then decided.Laparoscopic exploration enabled the fistula to be identified, with the aid of the pig-tail tract. Intraoperative endoscopy was performed to remove the esophageal prosthesis and visualize the location and limits of the fistula.We decided to perform a fistulojejunostomy as 'damage control surgery' because we chosed the quickest and least invasive procedure.The complete dissection of the oesophageal would have been complex, and would have necessitated a conversion to laparotomy, a gastrectomy and oesojejunal anastomosis with a high risk of secondary fistula.Postoperative follow-up was simple.Roux-en-Y-fistulo-jejunostomy is a procedure that has proved its effectiveness for chronic sleeve fistulas. We show here that it can also be used in acute fistula in the context of salvage surgery.