© 2012 S. Karger GmbH, Freiburg 1662–4033/12/0054–0538$38.00/0 Original Article Obes Facts 2012;5:538–545 Gastrobronchial Fistula as a Complication of Bariatric Surgery: A Series of 6 Cases Nasser Sakran a Ahmad Assalia b Andrei Keidar c David Goitein d, e a Department of Surgery A, Hillel Yaffe Medical Center, Hadera, b Department of Surgery, Rambam Health Care Campus, Haifa, c Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, d Department of Surgery C, Chaim Sheba Medical Center, Tel Hashomer, e Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel Key Words Morbid obesity  Laparoscopic sleeve gastrectomy  Roux en Y gastric bypass  Gastric leak  Gastrobronchial fistula Abstract Objective: To present a multicenter series of 6 patients who developed gastrobronchial fis- tula (GBF). GBF is a rare subtype of gastric leaks following bariatric surgery, which is the main- stay of treatment for the obesity pandemic. Methods: We retrospectively identified 6 patients with GBF (out of 2,308 cases performed: 0.2%). One patient had undergone Roux-en-Y gastric bypass, and 5 had a sleeve gastrectomy. Demographics, previous surgeries, clinical presenta- tion, timing of fistula diagnosis, diagnostic and treatment measures employed, and outcome were collected. Results: Four patients were female, the average age and BMI were 42 years and 42.5 kg/m 2 , respectively. Three patients had previous surgeries (Nissen fundoplication, adjustable gastric banding, and vertical banded gastroplasty). Median time to fistula diagno- sis was 40 days (range 15–90 days). Clinical presentation included chronic cough, hemoptysis, dyspnea and fever as well as persistent left pleural effusion or pneumonia. Diagnosis was con- firmed by computed tomography in all cases. Two patients were treated nonoperatively, while 4 eventually required surgery for resolution. Left lower lobectomy was necessary in 3 of 4 cases. Concomitant procedures were total gastrectomy in 2 cases and conversion of a sleeve to a gastric bypass in 1 case. Resolution occurred 30 days to 2 years after initial surgery. No mortalities were encountered. Conclusions: GBF is a rare but devastating complication fol- lowing bariatric surgery. It may develop as a late complication of a chronic upper gastric leak. Surgery is curative although nonoperative management may be warranted in selected cases. Copyright © 2012 S. Karger GmbH, Freiburg Received: Received: December 6, 2011 Accepted: January 22, 2012 Published online: July 27, 2012 David Goitein, M.D. Department of Surgery C Chaim Sheba Medical Center 2 Sheba Road, 56261 Tel Hashomer (Israel) Tel. +972 3 530 2714, E-Mail david.goitein @ sheba.health.gov.il www.karger.com/ofa DOI: 10.1159/000342012