Complications - Laparoscopic sleeve gastrectomy - general and visceral surgery
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General risks posed by the pneumoperitoneum and any adhesiolysis: Injuries to vessels and hollow viscera are possible from blind insertion of the Veress needle, but also from the optical trocar. The latter is the device of choice in patients with prior surgery.
Thermal injury to the intestinal wall must be respected and safely ruled out during adhesiolysis. If laparoscopic overview cannot be obtained, convert immediately to open surgery.
Always place other trocars under direct vision to avoid intra-abdominal injuries.
- Beware of the epigastric vessels; bleeding from trocar insertion sites is preferably managed with U sutures and fascial closure systems.
- Bleeding from the staple line -> oversew or clip
- Bleeding from retroperitoneal vessels (vena cava or aorta)
- Bleeding from the omentum
- If laparoscopic overview cannot be obtained, convert immediately to open surgery. Adhesions increase the risk of injury to retroperitoneal vessels.
Injury to adjacent organs:
- Spleen: Compression, hemostatics, thermal modalities, splenectomy as last resort
- Parenchymal laceration of the liver from retractor >hemostasis with monopolar current, compression, hemostatics
- Injury to the pancreas ->oversew, targeted drainage
- Injury to the esophagus with the large-bore gastric tube
Endoscopic management: Endo-clips plus injection of epinephrine, oversewing as necessary