Lipogems® for Gastro-Bronchial Fistula: A Case Report

Rare complication after sleeve gastrectomy proves hard to treat

A gastro-bronchial fistula (GBF) is an abnormal connection between the stomach and the airways. This serious complication can develop after laparoscopic sleeve gastrectomy, a common weight loss surgery. GBFs occur in less than three percent of bariatric surgery patients. However, when they do happen, they can cause fever, coughing while eating, difficulty breathing, and recurring lung infections. These fistulas are challenging to treat and often require multiple procedures.

Standard treatments failed in this 25-year-old patient

Researchers in Italy reported the case of a young man who developed a GBF five months after his weight loss surgery. He arrived at the hospital with fever, rapid heartbeat, coughing up blood, and severe weight loss. CT scans revealed a leak from his stomach that had created an abscess and connected to his left lung. The medical team tried several standard treatments:

• Surgical drainage of abscesses in the abdomen and lung

• Antibiotic treatments delivered directly to the lung

• Fibrin glue applied to the bronchial side of the fistula

• A self-expanding stent placed through endoscopy

Unfortunately, the stent migrated out of position within three days and had to be removed. The fistula remained open despite these multiple interventions.

Lipogems® injection offered a new approach

After the conventional treatments failed, the medical team turned to Lipogems® micro-fragmented adipose tissue. This technology uses processed fat from the patient's own body. The fat tissue contains pericytes (cells that support blood vessel healing) and mesenchymal stem cells (regenerative cells that can help repair damaged tissue). The Lipogems® material was injected directly into the fistula using a two-part approach. First, bronchoscopy allowed injection into the airway side. Then, endoscopy enabled injection around the stomach opening using a small needle.

Patient achieved complete healing within 18 days

The results were remarkable. The patient was discharged just 18 days after the Lipogems® procedure. His fistula had completely closed. There were no signs of infection or lung disease at discharge. The medical team followed him for eight months afterward. Serial CT scans showed complete healing with normal tissue restoration. His overall condition continued to improve throughout the follow-up period.

Only a few similar cases exist in medical literature

The authors note that autologous stem cell treatment for gastro-bronchial fistulas remains rare. Only about 75 cases of post-sleeve gastrectomy GBF have been reported in medical literature. Standard endoscopic treatments succeed in about 93 percent of cases. However, some patients need additional surgery—up to 69 percent in one study. For complex cases like this one, where standard approaches fail, Lipogems® offers a promising alternative.

What this means for patients with similar complications

This case report suggests that Lipogems® may help heal gastro-bronchial fistulas when other treatments have not worked. The procedure uses your own tissue, so rejection is not a concern. The injection can reach both sides of the fistula through minimally invasive techniques. While this is only a single case, the complete healing achieved is encouraging. If you have a fistula that has not responded to standard treatments, ask your medical team whether micro-fragmented adipose tissue therapy might be appropriate for your situation. A multidisciplinary team—including surgeons, endoscopists, and other specialists—should evaluate each case individually.

Source: Mongardini et al., Digestive Diseases and Sciences, 2022.