IBC Oxford University Poster Abstract 10 - Conversion to laparotomy for laparoscopic sleeve gastrectomy post endoscopic sleeve gastroplasty

Abstract Introduction Endoscopic Sleeve Gastroplasty (ESG)is an endoscopic minimally invasive weight loss procedure based on full thickness endoscopic suturing using Apollo’s Overstitch device. In the ESG procedure a series of sutures are placed through the gastric wall reducing the stomach volume by 80%creating a restrictive endoscopic sleeve. Case Discussion 52 years old lady with a Body mass index of 39 kg/m2 with previous history of Endoscopic gastroplasty (EGP) done 2 years before with no significant response regarding weight loss. Had been counselled for Laparoscopic Sleeve Gastrectomy (LSG). Preoperative gastroscopy showed loose intragastric sutures and wide stomach. During LSG tense gastric bed adhesions were noticed (suspected sealed old leak) during adhesiolysis a major arterial bleeding at splenic bed noticed that required immediate conversion to laparotomy. Bleeding from splenic artery was controlled by primary repair with proline sutures and sleeve Gastrectomy was performed open. Patient had smooth recovery. Follow up CT was performed 2 days after procedure that revealed patent splenic artery and no gastric tube leakage. Patient was kept for two weeks on low molecular weight heparin to avoid mesenteric vascular occlusion. Conclusion EGP can be converted to LSG for non-responders, but extra care should be taken during surgery especially if a sealed leakage is suspected from history or during procedure.