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. Résumé,

, Contexte Les fistules gastro-thoraciques (FGT) sont des complications graves, relativement peu décrites après chirurgie bariatrique et dont la prise en charge n'est pas consensuelle. Le but de cette étude était de constituer une large cohorte de cas de FGT provenant d'équipes de chirurgie viscérale et thoracique afin d'évaluer les différentes présentations cliniques et options thérapeutiques

M. Matériels, Etude multicentrique et rétrospective analysant les cas de FGT après chirurgie bariatrique en France de, 2007.

, 21 sleeve gastrectomies et 3 bypass gastriques) pour obésité de grade 3 (IMC moyen= 42 ± 8 kg/m²), provenant de 9 services de chirurgie : viscérale (n=5), thoracique (n=4) et d'un service de gastro-entérologie. La majorité des FGT (16/24) était des « FGT secondaires » à une fistule gastrique post-opératoire (FGPO) initiale, Résultats Vingt-quatre patients ont été inclus après une chirurgie bariatrique initiale

, La morbidité globale était de 42%. Le taux de succès global de la stratégie initiale a été de 58.5% (n=14/24). Le délai moyen de guérison était de 7 mois environ (209 jours [30-720]). Les patients ayant bénéficié d'une chirurgie thoracique (n=12) avant la résolution du problème au niveau abdominal ont présenté plus d'échecs de leur prise en charge initiale, depuis la chirurgie bariatrique avec un délai de 91 jours (4-236) depuis la FGPO pour les FGT secondaires. La majorité des patients (79%) était dénutris, justifiant d'un support nutritionnel dans la moitié des cas

, Les FGT après chirurgie bariatrique sont des fistules rares mais mettent en jeu le pronostic vital

, Leur prise en charge doit être pluridisciplinaire. La chirurgie thoracique est à réserver en dernier recours, une fois l'étage abdominal parfaitement cicatrisé car associée à un haut risque d'échec

, Mots-clefs : obésité, chirurgie bariatrique, complications, fistule complexe, fistule gastrothoracique, dénutrition