Laparoscopic Sleeve Gastrectomy: The Procedure



Fig. 17.1
Sleeve gastrectomy. The excluded stomach will be removed and discarded





17.4 Leak Testing and Closure


Once resection is complete, the staple line is inspected for defects and bleeding. Any bleeding should be controlled with surgical clips or suture as opposed to an energy source. The use of energy here could lead to thermal injury and delayed perforation. Most surgeons will then test the staple line’s integrity further using one of various methods. Commonly, the staple line will be submerged in irrigant, and an endoscope will be used to inflate the stomach. If air bubbles are seen, then a leak is present. An alternate method is the instillation of methylene blue dye via an oral gastric tube [2].

Some surgeons elect to leave a closed suction (Jackson-Pratt) drain along the staple line to aid in the diagnosis of leaks or hemorrhage. This practice has largely been abandoned as studies have revealed drains indeed do not facilitate the detection of leak or bleeding [3].

Once the surgeon is satisfied with the procedure, attention is turned toward closure. All laparoscopic ports greater than 5 mm should be closed at the fascial level. The CO2 is allowed to escape from the abdomen, the patient is returned to neutral position, and the skin is closed using absorbable suture and skin sealant.


Review Questions




  1. 1.


    What gas is typically used to insufflate the abdomen during laparoscopic procedures?


    1. A.


      Helium

       

    2. B.


      Compressed room air

       

    3. C.


      Carbon dioxide

       

    4. D.


      Carbon monoxide

       

     

  2. 2.


    Which of the following has the steps performed during a laparoscopic sleeve gastrectomy in the proper order?


    1. A.


      Anduction of anesthesia, takedown of the short gastric vessels, placement of the liver retractor, and resection of the stomach

       

    2. B.


      Placing the patient in reverse Trendelenburg position, takedown of the short gastric vessels, bougie placement, and resection of the stomach

       

    3. C.


      Placing the patient in reverse Trendelenburg position, takedown of the splenic vessels, bougie placement, and resection of the stomach

       

    4. D.
Jun 25, 2017 | Posted by in NURSING | Comments Off on Laparoscopic Sleeve Gastrectomy: The Procedure
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