An Eventful Sleeve Gastrectomy: A Case Report and Literature Review.

AIM

Sleeve gastrectomy is the most common bariatric procedure in Poland. The procedure leads to reduction of stomach volume by 85%, allowing the intake of food of approximately 100-150 mL. The complication rate is usually low as it is one of the least invasive bariatric procedures with a short recovery pathway.

CASE PRESENTATION

A 34-year-old male with a history of bipolar disorder and Body Mass Index of 46 kg/m² underwent a sleeve gastrectomy in a regional center. Due to anastomosis leakage diagnosed in the postoperative period, the patient was transferred to a referral bariatric center. The patient underwent revision laparotomy, during which a self-expandable metal stent was placed. After the revision surgery, the patient complained of stomach pain and left shoulder pain and gastroduodenal fistula was diagnosed. Vacuum wound therapy was initiated and a pigtail drain was implanted into the fistula canal. Despite multiple sessions of therapy, the patient developed recurrent thoracic empyema, ultimately requiring the creation of an esophago-ileal anastomosis. No further complications occurred, and the patient was discharged home in good condition.

RESULTS

Following early postoperative anastomotic leakage, the patient developed a gastric fistula. The recurrent thoracic empyema persisted despite multiple surgical and endoscopic interventions, including vacuum wound therapy, drainage, and stenting. Further, the patient required surgery to create an esophago-ileal anastomosis. The case shows a rare but complex and severe complication due to patient's incompliance regarding the calorie intake, volume and temperature of the meals and alcohol consumption.

CONCLUSIONS

In case of suspected postoperative complications after bariatric surgery, including bleeding or staple line leaks, referral to specialist bariatric center may be recommended. Patients should be strongly advised to follow the postoperative dietary recommendations to reduce the risk of complications.

© 2025 The Author(s).