Management of left hepatic artery injury during laparoscopic redo sleeve gastrectomy

The problem of revision of failed gastric banding (GB) procedure has become a common situation in bariatric surgery. This video presents a re-intervention in a female patient who had her gastric band removed and decides to have a laparoscopic sleeve gastrectomy.

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Management of left hepatic artery injury during laparoscopic redo sleeve gastrectomy

Authors

M Vix, J Marescaux

Abstract

The problem of revision of failed gastric banding (GB) procedure has become a common situation in bariatric surgery. This video presents a re-intervention in a female patient who had her gastric band removed and decides to have a laparoscopic sleeve gastrectomy.

Classification

tips and tricks

Keywords

Management, left hepatic artery injury, laparoscopic redo sleeve gastrectomy

Media type

Surgical video

Duration

04'15''

Publication

2011-02

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E-publication

WeBSurg.com, Feb 2011;11(02).
URL: http://www.websurg.com/doi-vd01en3110.htm

Management of left hepatic artery injury during laparoscopic redo sleeve gastrectomy

1. Introduction 00'19''

This video presents a re-intervention in a female patient who had her gastric band removed and decides to have a laparoscopic sleeve gastrectomy.

2. Intra-abdominal adhesions 00'29''

On entering the abdomen, several adhesions are found making the access to the stomach difficult. In particular, gastro-hepatic adhesions make access to the operative field totally impossible. Consequently, an extensive dissection of these adhesions becomes necessary.

3. Injury of left hepatic artery 00'50''

The dissection is carried out cautiously in contact to Glisson’s capsule. During this dissection, a left hepatic artery is wounded.

4. Clamping of hepatic artery 01'03''

The artery is clamped by a forceps. The operative field is cleansed and an additional port is introduced in order to achieve an easier clamping, hence clearing up the operative field. This forceps is given to an assistant and once the region has been cleared once again by means of aspiration, the dissection is carried on in order to obtain a larger space and control the injury to the left hepatic artery.

5. Artery control 01'46''

Adhesions between the liver, the stomach, and the lesser omentum are dissected carefully in order not to cause another vascular lesion in this area. A gauze pad is pushed towards the liver to improve the dissection. The forceps holding the artery has moved and the bleeding that ensues must be controlled again. The forceps is placed on to the orifice in an appropriate fashion. At this time in the procedure, a ligature is decided upon. It is performed on each side of the artery.

6. Artery ligation 02'42''

A non-absorbable suture is used. A first stitch is placed close to the stomach. A second stitch will be placed close to the liver on each side of the artery’s wound in order to allow for a perfect hemostasis. This maneuver is facilitated by the use of a knot-pusher. Traction exerted on the liver allows both to retract and occlude the artery, hence facilitating the placement of a second stitch. The exploration of the region does not show any other abnormality.