Bariatric Times

Sleeve Gastrectomy 2015

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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April 2015 • Supplement A • Bariatric Times A11 5 th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY Novadaq Technologies Inc., Bonita Springs, Florida, United States). T issue with good perfusion will uptake the ICG and will be shown as green fluorescence (Figure 2). The brighter the fluorescence the better the tissue perfusion (Figure 3 ). This technology is particularly applicable in complex revisional cases where tissue dissection can lead to development of tissue ischemia. Ischemic tissue left undetected can lead to perforation or staple line leaks. If relative ischemia or poor tissue perfusion is detected along the staple line, some maneuvers that can be performed to minimize staple line leaks include oversewing of the staple line, buttressing the staple line with an omental patch, or using a fibrin sealant. CONCLUSIONS Staple line leak is a dreaded complication associated with LSG. It is critically important for surgeons to avoid narrowing of the gastric incisura during construction of the sleeve. In revisional cases, it is important to select the appropriate stapler load based on the thickness of the gastric tissue. It is always better to err on the side of using a thicker stapler load (green stapler load) to minimize the issue of stapler malformation or failure. Lastly, in cases with potential for development of tissue ischemia along the staple line, the use of fluorescence imaging may detect the site of poor perfusion and certain operative intervention may be performed to minimize the risk for development of postoperative staple line leaks. REFERENCES 1. Clinical Issues Committee of American Society for Metabolic and Bariatric Surgery. Updated position statement on sleeve gastrectomy as a bariatric procedure. Surg Obes Relat Dis. 2010;6(1):1–5. Figure 1. Laparoscopic view of a completed sleeve g astrectomy, prior to injection of indocyanine green for fluorescence imaging Figure 2. Laparoscopic view using a fluorescence imaging system showing good tissue perfusion of the sleeve gastrectomy, particularly along the medial aspect of the sleeve Figure 3. Close-up view of the sleeve gastrectomy using the Pinpoint fluorescence imaging system (Novadaq Technologies Inc., Bonita Springs, Florida, United States) showing good tissue perfusion along the entire staple line

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