A stepwise treatment of gastrobronchial fistula after laparoscopic sleeve gastrectomy: A case report"

Bariatric surgery has quickly emerged as one of the most effective treatments for obesity in the world and is mostly known as a safe and effective method; however, in some cases, it may lead to life-threatening complications. One of these complications is fistula, which may result in high mortality and morbidity. The treatment methods for this condition have been subject to ongoing discussion, ranging from endoscopic procedures to surgery. However, the outcome of each approach remains uncertain for both patients and surgeons. A 21-year-old man presented with pulmonary symptoms such as cough, pleuritic chest pain, and fever two months after laparoscopic sleeve gastrectomy and in further investigations, the diagnosis of gastrobronchial fistula (GBF) was confirmed. The treatment of the patient was based on endoscopic procedures and prioritizing minimally invasive methods over surgical interventions. The treatment approach that is recommended for patients with GBF is the stepwise method, in which the next step is performed according to the patient's condition. Also, the treatment was based on minimally invasive procedures like endoscopic-based methods, also it is advisable to avoid conducting invasive treatments such as surgical procedures until the patient has shown a response to either non-invasive or minimally invasive treatments. The key finding of this case report emphasizes that in situations of acute or unstable conditions or even if there is still hope for treatment, it's better to avoid invasive procedures. Rather, opting for non-invasive or minimally invasive treatments is favored to stabilize the patient's clinical or lab parameters, or to maintain a steady and consistent weight. Therefore, it is advisable to refrain from or delay surgical and invasive procedures during the acute stages or when a GBF is newly diagnosed, allowing the patient to attain a more stable clinical condition and use surgical approaches as a complementary choice besides minimally invasive procedures.