OPERATION: Laparoscopic Sleeve Gastrectomy
ANAESTHETIC: General anaesthesia
INDICATION: Morbid obesity
POSITION: Legs apart, first surgeon between legs.
FINDINGS: Liver shrinkage diet effect. Conventional anatomy.
PROCEDURE:
Pneumoperitoneum via Veress needle and Visiport - no complications.
4-5 ports including Nathanson liver retractor.
Greater curve of stomach mobilised with Harmonic from 6cm proximal to pylorus up to fundus and angle of His. Gastroepiploic vessel protected.
36F orogastric tube placed along lesser curve towards pylorus.
Greater curve resected lateral to tube with EndoGIA staplers (Black 45, Purple 60, Gold 60 as required). Seamguard buttress used as appropriate. Slender sleeve conduit achieved.
Methylene blue leak test - no leak. Haemostasis confirmed.
Remnant stomach retrieved through largest port and sent for histology.
All ports removed under direct vision.
BLOOD LOSS: Minimal (less than 50ml).
CLOSURE:
3-0 Monocryl to skin. 40ml levobupivacaine to port sites.
POST-OPERATIVE INSTRUCTIONS:
Bariatric protocol. Sips today, oral fluids as tolerated.
Omeprazole 40mg IV once daily. Dalteparin at 20:00.
Mobilise within 4 hours. Bloods the following morning.