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

- 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