Endoscopic fibrin sealing of high-output non-healing gastrocutaneous fistulas after vertical gastroplasty in morbidly obese patients.

BACKGROUND

Fibrin glue was used in a various fields of surgery during the last 15 years, but its use has not been reported in bariatric surgery yet.

METHODS

In 2 out of 215 morbidly obese patients who underwent vertical banded gastroplasty, a non-healing gastrocutaneus fistula (GCF) developed. In both patients sepsis occurred, caused by a leak of the posterior gastric wall, which was managed by means of an unsuccessful reoperation. After that, sepsis recurred, and a non-healing GCF developed. These GCF were managed endoscopically by the use of a fibrin sealant (Beriplast P 2 ml set, Behring) as a tissue adhesive.

RESULTS

One injection was needed for the first case and six for the second in achieving full healing of the fistulas. No evidence of fistula was observed at gastroscopy 3 and 24 months after the end of therapy.

CONCLUSIONS

Endoscopic use of human fibrin sealant is simple, safe, effective and in some cases life-saving. This is a therapeutic option in high output GCF in morbidly obese patients.