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Laparoscopic Gastric Bypass Roux Y Limb [75-150cm]

Last Technical Rev. Dec 31, 2015 

LGBRY: STANDARD TECHNIQUE [Last Validation Dec 31, 2015 - PSJMC] 

MANAGEMENT OF COMPLICATIONS AND POST-OPERATIVE EVENTS

- Intraoperative Splenic Tear / Laceration with Hemorrhage [EVENT LG35]:

  • Check IV Access in patent / PRC on call.

  • Use high suction and irrigation to clear surgical area.

  • Attempt to place compression with local structure or direct compression with a blunt grasper.

  • Identify site: Splenic Parenchyma vs Hilar vessels vs Short Gastric vessels: If vessels attempt to clip [must have sufficient clearance and may need additional trocar to be inserted.

  • Parenchymal tears:

    • Small: use grasper connected to low cautery and gently cauterize the surface until an eschar is created.

    • Long-Large: Insert a marked 4x4 rolled and apply against tear. Wait. Check. Repeat. Wait. Check

  • If bleeding cannot be controlled, be ready for a laparoscopic or open splenectomy.

 

- Tension on Gastro-enteric, anticolic anastomosis [EVENT LG73]

  • Do not fire until tension is relieved.

  • Route Roux Limb as lateral as possible.

  • Retro-colic Roux Y placement alsmot never has tension.

  • Lenghten cut on the Roux Y mesentery - attention not to create a ischemic tip of the limb.

  • Cut the omentum behind the Roux Y Limb with SONICISION.

 

- Intra-op HIGH RISK FOR COMPLETION OF LGBRY [EVENT LG36]

  • Convert to LapSLeeve - or - 

  • Abort Procedure.

 

- Post-op Bleeding Via Blake Drain in PACU or Floor

       VERIFY LINE ACCESS

  • HIGH FLOW: > 60cc - 30 Min - sustained x 1.5 hour - with stable VS: Return to OR for Laparoscopy

  • LOW FLOW: < 30 cc - 30 Min - Sustained

    • Normal BP - Tachycardia: 1000 cc NS BOLUS / Monitor / CBC Monitor Platelets and Hg

    • Syncopal Episode - Tachycardia: Return to OR

 

 

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