Kenneth Copperwheat, DO, Gerrit Dunford, MD, Patrick Sowa, MD, Rami Lutfi, MD, FACS, FASMBS. St. Joseph Hospital, Chicago
Here we present a video case report of a successful laparoscopic sleeve gastrectomy after a case of severe pancreatitis requiring deviation from standard operative technique. During the index operation, upon dissection into the lesser sac, we unexpectedly encountered multiple dense and focal adhesions. Though his preoperative esophagogastroduodenoscopy was unremarkable, we were ultimately concerned about the possibility of a chronic penetrating gastric ulcer or pancreatic neoplasm. Due to diagnostic uncertainty, the procedure was electively aborted. Postoperatively, he revealed that he had been hospitalized five years prior for severe pancreatitis. Imaging reviewed from that hospitalization was concerning for peripancreatic fluid collections and possible necrosis. Repeat imaging did not demonstrate a discrete mass; however, there were adhesive fusions between the stomach and pancreas. During the second operation, the same adhesions from the index operation were encountered. Despite careful dissection, a 2x2cm section of posterior gastric wall remained fused to the splenic vessels and pancreas, and was unable to be safely removed. After careful consideration of the location of the fused area, we determined that it was sufficiently lateral and would be contained within the removed specimen, and thus excluded from the neostomach of the sleeve gastrectomy. The remainder of the sleeve gastrectomy was completed in the standard fashion, and the patient recovered as expected postoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94573
Program Number: V278
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop