- Bleeding
The most common complication is bleeding from the gastric/EE staple line, which can be prevented almost completely by reinforcing the staple lines with sutures. Bleeding requiring blood transfusion is seen in up to 8% of patients. With <2% revision surgery is much less common.
- Contact between the active plate of the ultrasound device and the left gastric artery
Oversew or seal the defect and fashion a micropouch to prevent pouch necrosis. Best prevent the latter by strictly dissecting close to the gastric wall.
- Efferent limb too short
To avoid fashioning a limb that is too short, first check that the efferent limb is long enough to reach the pouch. If the limb proves to be too short nevertheless, it is recommended to fashion a primary gastric sleeve-like pouch and/or skeletonize the efferent limb or bring the limb up via a retrocolic retrogastric route.
- Blue loop syndrome
To avoid a twisted limb (“blue limb” syndrome), bring up the limb under direct vision (with the mesentery pointing to the left). Correct and eliminate any limb rotation.
- Limb misidentification
Consistent identification of the ligament of Treitz is crucial to also ensure that the limbs are not misidentified. Any misidentification of the limbs must be corrected immediately since otherwise the overstretched stomach (distension) carries the risk of cardiac arrest. Caution: Gaining access to short afferent limbs during revision surgery is technically challenging.