Abstract
RATIONALE: Laparoscopic sleeve gastrectomy (LSG) is a widely utilized and effective procedure in metabolic and bariatric surgery (MBS). Stapler line leakage is one of the most catastrophic complications of LSG. Although there are various available treatment options for refractory leakage, there is currently no standardized protocol. In this case report, we present a treatment option for a chronic gastric fistula following LSG, performed as a salvage treatment after the failure of several conservative management techniques. We also reviewed the literature to contextualize our case within the spectrum of treatment strategies for refractory fistulas. PATIENT CONCERNS: A 45-year-old woman underwent LSG 7 days prior to presentation. The patient presented to the emergency department with abdominal pain and fever. DIAGNOSES: She was diagnosed with a gastric leak following LSG. INTERVENTIONS: The patient underwent an emergency surgery for generalized peritonitis and hemodynamic instability, during which multiple drains were placed in the abdomen. Furthermore, the patient was managed conservatively, including endoscopic vacuum therapy for 3 months. OUTCOMES: The leakage persisted despite these interventions. Complete total gastrectomy was performed 3 months later, and the patient was discharged 27 days after the surgery. LESSONS: If conservative treatments fail to resolve leakage, delayed total gastrectomy should be considered as a definitive treatment option for refractory leaks.