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QI - Analytics & Adverse Events Protocols

Routine Hiatal Hernia Repair during Standard Sleeve Gastrectomy

[Approved Quilici-Tovar 2014]

Hiatal hernias found at the time or diagnosed prior to a Laparoscopic Sleeve gastrectomy should be repaired using the following guidelines:

1. Crural closure should be done ONLY. No fundoplication.

2. Should be repaired if a hiatal hernia is calibrated and found to be 1 cm > 60Fr Bougie. All deviation should be reported.

3. These guidelines DO NOT apply to paraesophageal hernias.

4. Patient should be informed pre-op if diagnosis is made pre-operatively.

5. Patients with GERD should be proposed a LGBRY. If proceeding to Lapsleeve, proper disclosure should be made that the bariatric procedure may worsen GERD.

Source: Review of Lit. 2014


[May 15 Meeting]

Controversies in Obesity Management /

Institute for Clinical and Economic Review

Year 2014-15 / Final Meeting June 23, 2015

Dr. P. Quilici - Participant, Panel Member and Voting Member


PHS will implement findings and recommendations.


Approved Feb 2015

All Bariatric Adverse Events [Mortality and All Major Morbidity i.e. Re-exploration, Re-admission, LOS > 4 days, Major TEE, PRC Transfusion will be reported within 7 days to the Bariatric Weekly Staff meeting and evaluated for RCA classification, Prevention and Clinical Pathway modification. All Mortality Events will require a full analytic report to be approved by the Chief of Service, filed with Surgical Review and to be inserted in the TransMed and EPIC patient chart.

PSJMC Peer Review Process will independently analyse and grade the Bariatric Service Performance and adverse events using the medical staff screening procedures, will schedule appropriate peer review meetings and report its findings to the Surgical Review Committee [reporting to the Dept. of Surgery Committee, reporting to MEC].

Effective Jan 1, 2017, PSJMC Bariatric Service will oversee the Digestive Health - Bariatric Performance Evaluation Process.



Chairs: Philippe Quilici, MD / Rob Clinton

High Performance Service Lines: Implementation New Clinical Pathways

[Approved Quilici-Tovar 2014-15]

New Clinical Pathways for EPIC PRODUCTIONS APPROVED.

1. Lap Sleeve


3. LapBand

4. Revisional Surgery [Not inserted in EPIC YET]

5. Intake Pathway

Routine Closure of Mesenteric Defect for LGBRY - New Guidelines

[Approved Quilici-Tovar 2014]

Routine closure of the mesenteric defect for LGBRY should be done when technically feasible and safe in all patients. For patients classified as Super-obese for weight > 450 or very high BMI, the defect may be left open if it creates unsafe tension of the Roux Y Limb or the gastro-jejunal anastomosis. Proper documentation required.

Case data: 321 LGBRY WO MC vs 621 LGBRT W MC.

Laparoscopic Sleeve Gastrectomy: Running Re-inforcing Suture for Gastric Staple Line NOT to be done routinely

[Approved Quilici-Tovar 2015]

Routinely re-inforcing the gastric staple line during laparoscopic sleeve gastrectomy is shown not to improve staple line integrity or hemostasis. Results are the same using M Hemoclips to reinforce the gastric staple line.

Implementation COVIDIEN VERSASTEP TROCARS no longer demonstrating an outcome clinical enhancement [Trocar site hernias and trocar related events] in large scale analysis for trocar placement ABOVE THE UMBILICUS - Unit cost at $124.54 vs Generic Standard 12mm Trocar at $38.00.

[Approved Quilici-Tovar Aug 1, 2016]

                                                  Effective Aug. 15, 2016 - VERSASTEP TROCARS will be

                                                     removed from standard LS and LGBRY procedures.

Routine Use of Re-inforced Staple COVIDIEN Cartridges not found to improve surgical outcomes in head to head prospective data analysis [172 vs 161 using DUET C 60 & Reinforced Tri-staple C].

[Approved Quilici-Tovar 2015]

Will keep stock for selected clinical situtations and revisional bariatric procedures. PAR decreased to 15 B and P.

Implementation MANAGEMENT OF ANTICOAGULANTS IN THE PERI-OPERATIVE ARENA IN BARIATRIC PATIENTS - Response to Sentinel Event July 16: Severe, Critical Delayed Post Op Bleed in AC LapSleeve Patient.

[Approved Quilici-Tovar Aug 1, 2016]

GUIDELINES DOCUMENT APPROVED FOR USE: AC Management for Bariatric Patients

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