Peer Review Report For: Case Report: Gastro-bronchial fistula complicating a sleeve gastrectomy: from a glimmer of hope to a plight [version 1; peer review: 2 approved with reservations]

Résumé

Background Bariatric surgery, particularly sleeve gastrectomy (SG), has emerged as an effective long-term treatment for morbid obesity. Despite its benefits, howver, it may result in severe complications. One rare but serious postoperative issue is the development of a gastrobronchial fistula (GBF), a condition with a challenging diagnosis and management pathway due to its insidious nature. Case Presentation We report the case of a 36-year-old woman who underwent sleeve gastrectomy in 2015. The early postoperative course was complicated by a gastric fistula that was managed with double pigtail stents. Subsequently, the patient developed recurrent bronchopulmonary infections, and imaging in 2017 revealed a GBF connecting the gastric remnant to the bronchial tree. Initial endoscopic management with stenting failed because of migration. Definitive surgical management involved complex adhesiolysis and creation of tension-free fistula-jejunal anastomosis. Postoperative recovery was uneventful, and the patient remains asymptomatic. Discussion Gastrothoracic fistula post-bariatric surgery is a rare but potentially life-threatening complication. Their development is often linked to the insufficient treatment of early gastric leaks or collections. Diagnosis is frequently delayed owing to nonspecific respiratory symptoms. Endoscopic approaches have show limited success, and surgical management, often complex, is frequently necessary. Multidisciplinary strategies, including endoscopic and surgical options, are vital for achieving favorable outcomes. Conclusion Gastrobronchial fistulas represent a diagnostic and therapeutic challenge following sleeve gastrectomy. A high index of suspicion, long-term follow-up, and tailored multidisciplinary approach are essential for effective management and resolution. Awareness of this rare complication should prompt early detection and intervention to reduce the morbidity and mortality.

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