Gastrocolic Fistula Due to Staple Line Leak Following Metabolic Bariatric Surgery: A Systematic Review

Gastrocolic fistula (GCF) is a rare but serious complication following metabolic bariatric surgery (MBS), primarily caused by leaks from the staple line or anastomotic sites. This systematic review aims to comprehensively analyze the diagnosis and management strategies for GCF following MBS. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, Web of Science, and EMBASE were searched until March 2024. Studies were independently screened and extracted using the PRISMA checklist. This systematic review included 16 studies (13 case reports and three retrospective cohort studies). GCF was most prevalent in laparoscopic sleeve gastrectomy (LSG), accounting for 81.2% of the studies. The transverse colon was the most common site of occurrence. Exploratory laparoscopy was utilized as the final treatment or rescue surgery in 85.7% of GCF case report studies, with all patients successfully healed following these interventions. The time from diagnosis to closure of the GCF varied significantly: in acute studies, closure occurred between 14 and 61 days, while in chronic studies, it ranged from 1 to 12 months. This systematic review concludes that surgical intervention should be recommended for managing GCF following specific staple line leaks in LSG. Most GCF studies occurred more than 6 months post-surgery, indicating a late complication. Computed tomography (CT) was the most frequently used diagnostic tool. Although over-the-scope clips (OTSC) and stents were employed, their efficacy as primary treatments remain questionable due to limited and inconsistent study outcomes.