Antonio M Lacy (Director of the gastrointestinal surgery department)
Maria Fernandez-Hevia (Gastrointestinal surgery specialist)
Gabriel Diaz (Gastrointestinal Surgery specialist)
Hospital Clinic, Barcelona – Spain
A 64-year-old female with a history of morbid obesity BMI 50 Kg/m2 (Weight 139 Kg) and severe obstructive sleep apnea was to undergo a sleeve gastrectomy.
The patient was placed in the standard position and a total of 5 ports were used.
A 32Fr nasogastric tube is placed by the anesthesiologist and its distal part is placed at the pylorus by the leading surgeons. This is a special device equipped with a light that guides surgical dissection.
The anesthesiologist unfolds it and adapts it to the greater curvature, with the pylorus remaining excluded. By means of this strategy the stomach is uplifted and separated from the retroperitoneal plane. Dissection becomes easier.
Unlike in standard dissection, the leading surgeon pulls up the stomach with his left hand and performs the section with the LigaSure™ in his right hand.
This is a good approach as you can dissect the greater curvature and the posterior wall of the stomach at the same time. By releasing these adhesions the surgeon can achieve a good shape for the sleeve gastrectomy.
The fundus is also approached from below. The surgeon’s left hand is essential to improve exposure. This approach also makes it possible to fully mobilize the fundus.
Now the lighted tube is used to delimit the remnant pylorus and the caliber of the gastrectomy. the surgeon should avoid placing the mechanical suture too close to the device, to avoid tension and bleeding from the stapler line.
The rest of the resection follows as a standard sleeve gastrectomy, making the last firing 1 cm from the angle of His. This is the final look after the surgical resection.
There were no complications and the patient left hospital two days after surgery.