Preventing Complications

Abstract

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the bariatric surgical technique of choice, but also it is difficult to perform, requiring a long and demanding learning curve. The possible post-operative complications are, frequently, a consequence of adverse intraoperative events (AIEs) or inadequate surgical manoeuvres. In this chapter, the most accurate technical details to prevent post-operative complications are evaluated.

Any kind of trocar insertion can deserve injuries to great vessels, visceral, solid organs or abdominal wall. To prevent them, it is recommended to introduce the first trocar directed to the patient’s left side of the upper abdomen and to check the sites at the end of surgery. Post-operative haemorrhage, intra- or extraluminal, is prevented by carefully looking for bleeding points, by using the adequate stapler cartridge and reinforcing it, if necessary. Anastomotic stenosis, above all at the gastrojejunostomy, is more frequent with 21 mm circular-stapler or handsewn suture, being less likely with linear stapler as well as using reabsorbable and monofilament sutures. Great attention must be paid to avoid the “Roux-en-O”, the kinking of the limb and the trapping of the oro- or nasogastric tube, as well as to control staplers’ management to prevent their failures and to resolve them. Passing the alimentary limb antecolic and antegastric, with its tip oriented to the patient’s left and with a anti-clockwise alimentary limb position at the jejunojejunal anastomosis, besides closing mesenteric and Petersen’s defects, is the most suitable manoeuvre to prevent internal hernias.

In summary, close attention to technical details and laparoscopic surgical manoeuvres, using delicate and precise surgical instruments, besides surgeon’s experience and skilfulness, based on a tutorized learning, are the best preventive measures.