Laparoscopic Sleeve Gastrectomy
Indications:
BMI >40
BMI>35 w/ weight related comorbidity (ie diabetes, OSA, HTN, HLD, CAD)
BMI between 30-35 w/ uncontrollable type 2 DM
Bridging procedure before duodenal switch
Contraindications:
Prohibitive anesthesia risk
Severe uncontrolled psychiatric illness
Coagulopathy
Barrett’s esophagus
Uncontrolled severe GERD
Image from google images
*sleeve gastrectomy involves removal of approximately 80% of the stomach
The celiac trunk blood supply
From medchrome.com
General Surgical Steps
1)Pre-operative (Pre-op nutrition and psych counseling; thorough H&P; DVT prophylaxis pre-op; ABX prophylaxis)
2)Positioning (supine arms out, or tucked in. Appropriately pad!)
3)Entry
-Veress needle over palmers point, (gasless) optiview, Hasson
-Inspect for any entry injuries
4) Trocar placement
4) Enter lesser sac via gastrocolic ligament
5) Free up stomach laterally (take down gastro-epipoloics)
6) Clear left crus, inspect GE junction
7) Stapler time (start 2-6cm from pylorus)
8) Leak test (can use EGD or insufflating bougie)
9) Extract Specimen
10) Closure
Staple heights
Complications include:
Bleed, leak, stricture