IBC Oxford University Oral Abstract 11 - Video abstract: major vascular injury during laparoscopic sleeve gastrectomy

Abstract Introduction Laparoscopic Sleeve Gastrectomy (LSG) had been recognized as the most performed bariatric procedure worldwide. Major vascular injury during the procedure is a rare life-threatening complication that needs an immediate integrated response to avoid possible mortality and serious morbidities. Case Presentation A 26-year-old lady with a BMI of 35.5 kg/m2 had presented to surgical clinic for bariatric surgery. After proper counselling and routine preoperative work up showed normal blood results and abdominal sonography showed fatty liver and cholelithiasis. Patient had been counselled for LSG and Laparoscopic Cholecystectomy. After induction of anaesthesia, pneumoperitoneum had been achieved using a Verres needle in left upper abdominal quadrant then a 10 mm camera port (bladed trocar) had been inserted two fingers above and to the left of umbilicus. Once camera inside some fresh blood had been noticed in central abdomen, A quick second 10 mm trocar had been inserted at the left abdominal side to explore the source of bleeding that was mostly from a major vessel due to rapid expansion. Anaesthesia team was informed immediately to resuscitate and prepare adequate blood and blood products and to keep enough IV lines ready. Senior surgical team had joined the table and quick midline Laparotomy performed to explore source of bleeding. Sharp linear cut was identified in the Inferior vena cava (lateral wall), Right Common iliac artery (front and right wall). Compression control done while Anaesthesia team was resuscitating the patient successfully, Vascular team had been called from a nearby hospital and joined the table within 30 minutes. successful repair of injured vessels had been achieved within 45 minutes. Formal abdominal inspection had been done to rule out any missed injury followed by closure with drains. Patient shifted to surgical ICU ventilated with stable vital signs, adequate urine output and Hb of 12 g following 4 packed blood transfusion. Follow up Hb was stationery and patient extubated successfully after 12 hours. Patient had smooth recovery and discharged home after 3 days. Conclusion Major vascular injury might happen during bariatric surgery that needs immediate multidisciplinary response to achieve an integrated decision making and proper management, otherwise mortality or major morbidities might occur even in higher centers.