+ Roles of Laparoscopic Sleeve Gastrectomy in Bariatric Surgery Vincent Lau TKOH.
Golden steps to perform laparoscopic sleeve gastrectomy
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Transcript of Golden steps to perform laparoscopic sleeve gastrectomy
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Laparoscopic Sleeve Gastrectomy
Golden Steps
Dr. Deep Goel, FACS (USA), FRCS (England)
Director Department of Surgical Gastroenterology, Bariatric & Minimal
Access SurgeryBLK Super Specialty Hospital
New Delhi, India
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Positioning
• Supine / Split leg
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Port Placement
123 4
5
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Liver Retraction
• Proper liver retraction for adequate view
of GE junction
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Greater Curvature Mobilization
• Starting from mid body- up and down
• Remain close to stomach wall
• Congenital posterior adhesions
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Short Gastric Vessel
• Harmonic
• Enseal
• Clip
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Fundal Mobilization
• Complete mobilization
• Visualize left crus
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Staple Fire
• First staple fire 2-4 cm from pylorus
• Avoid narrowing at incisura
• Avoid excessive traction on tissue while stapling
• Stapler should go to the tissue rather getting tissue to
the stapler
• Check the angle for loose staples and tissue
• Clean the crotch of stapler before changing cartridge
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Choice of Cartridge
• Green
• Gold
• Blue
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Gastric Calibration Tube (GCT)
• 36 French Vs UGI endoscope 28 French
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Excise Complete Fundus
• Landmark
–Belsy’s fat – medial / lateral
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Leak Test
• Air insufflation test
• Methylene blue test
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Staple Line Bleed
• Raise BP 150 mmHg systolic
• Clip
• Suture
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Bag Vs No Bag
Removal of Excised Stomach
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• Port site irrigation
• Closure of port
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Controversies
• Buttress material
• Over-sewing
• Post-op gastrografin study
• Drain
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Thanks