Inclusion of a Clip Inside the Cartridge and Failure of the Stapler When Performing a Laparoscopic Sleeve Gastrectomy
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BRIEF COMMUNICATION
Inclusion of a Clip Inside the Cartridge and Failure of the Stapler When Performing a Laparoscopic Sleeve Gastrectomy Gabriel A. Molina 1
&
William G. Aguayo 1 & Christian L. Rojas 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The growth of the surgical industry and the development of surgical techniques have allowed us to achieve better results for patients. Laparoscopic staplers are a crucial tool in laparoscopic surgery, and despite their proven safety and efficiency, they have been associated with technical and mechanical failures on rare occasions. Adequate knowledge of the surgical instruments is critical to accomplishing optimal results and to adequately treating these rare malfunctions and their consequences. We present a case of a surgical stapler malfunction due to a titanium clip during laparoscopic sleeve gastrectomy. This mechanical failure produced a complication that was adequately resolved, and the patient completely recovered. Our brief communication shows that errors during sleeve gastrectomy can occur, and that precise surgical skills along with a close follow-up are crucial to improve the patient outcome when these rare complications arise. Keywords Bariatric surgery . Staple malfunction . Laparoscopic sleeve gastrectomy
Introduction Laparoscopic staplers are an effective and useful tool during surgery. They provide a fast way to divide and join the bowel and are easier to use in comparison to laparoscopic hand suturing [1, 2]. During bariatric surgery, these instruments have become essential due to their efficacy and the improved safety they provide. However, complete knowledge of the instrument and its operation is essential to obtain adequate results [2, 3]. Though rare, there have been reports of malfunctioning staplers in laparoscopic procedures resulting in severe complications that required reintervention or conversion to open procedures [1–4]. We present a case of an obese 31-year-old patient who presented a 6 cm gastric laceration caused by a stapler malfunction, due to a titanium
* Gabriel A. Molina [email protected] William G. Aguayo [email protected] Christian L. Rojas [email protected] 1
Grupo Digeslap Center, Quito, Ecuador
clip, during his laparoscopic sleeve gastrectomy. The injury was handled properly, and the patient underwent full recovery.
Case Report Patient is a 31-year-old male with a past medical history of obesity. He sought surgical consultation since his body mass index (BMI) was high (BMI = 41) and he had failed numerous attempts to lose weight over the past 5 years. Since his preoperative exams were normal, a laparoscopic sleeve gastrectomy (LGS) was planned. The patient was prepared and positioned for surgery in a supine position. During the procedure, we used one 15 mm port, one 12 mm port, and three 5 mm ports. A 30° telescope was used as it provided excellent visualization of the angle of His. A grasper was used as a liver retractor to elevate the left lobe of the liver and to as
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