LAPAROSCOPIC SLEEVE

GASTRECTOMY DICTATION
Dr.Hassan’s operative notes for Laparoscopic sleeve gastrectomy in a nutshell

 Note:
o This operative note was taken from surgical books and tailored as what we are doing in our

institution.

o This note is only to help you in guide you in operative dictation and it should not be always

the same.

o You can manipulate the note according to the actual operation done in your institution.

o Some surgeons have different techniques so you have the right to manipulate the note.

[DATE]
[COMPANY NAME]
[Company address]
Preoperative Diagnosis: morbid obesity.

Procedure: Laparoscopic sleeve gastrectomy.

Postoperative Diagnosis: Same

Anesthesia :

 General anesthesia with endotracheal intubation and assisted mechanical ventilation.

Position of patient:

 Supine in split leg position with steep reverse Trendelenburg tilt. Arms secured and adducted, knees
secured with crape bandage and legs secured with a footboard.

Procedure :

 Time-outs were performed using both pre-induction and pre-incision safety checklists to verify correct
patient, procedure, site, and additional critical information prior to beginning the procedure
 Pre-operative antibiotics given as per policy.
 Pneumatic compression device applied to lower extremity and turned on.
 An orogastric tube is placed to decompress the stomach
 Antiseptic prepping and draping done using chlorhexedine solution.
 Peritoneal access achieved using supraumbilical incision and optiport inserted, insuffilation of Co2 done
with pre-set pressure of 15mmhg.
 Other ports inserted as follow:
o 15\5 mm port in right subcostal midclavicular line
o 5 mm port in subxiphoid area.
o 12 mm port in left subcostal midclavicular line.
o Fixed retractor (Nathanson retractor) was used through the 5mm subxiphoid port.
 the pylorus was identified, at almost 4–6 cm proximal to the pylorus along the greater curvature of the
stomach all the vessels along the greater curvature and all the short gastric vessels were sealed and
divided completely freeing up the greater curvature and the fundus of the stomach.
 The stomach was lifted up and all posterior attachments to the pancreas were divided using LigaSure.
 The plane between the cardia and left crus of the diaphragm was opened to expose the left
diaphragmatic crus.
 No diaphragmatic hernia identified.
 Then a 36-Fr orogastric tube was placed by the anesthesiologist and oriented toward the antrum snug
along the lesser curvature.
 Alongside the tube the stomach was stapled and divided sequentially in a vertical fashion heading
toward the angle of His.
 We used a total of six cartridges 60 mm in length with 4.8-mm staple height.
 Intraoperative methylene blue test done and no leak along the staple line was identified.
  The staple line was reinforced with a running 2-0 PDS serosa-serosa imbricating sutures.
 The stomach was retrieved through the right subcostal port site, the fascia at this port was sutured.
 Heamostasis maintained and assured.
 All ports removed under direct vision.

Closure and disposition :

 The wounds were closed with 3-0 absorbable subcuticular sutures.

 Steri-Strips/sterile dressing applied.
 The patient was extubated in the OR he tolerated the procedure well and shifted to post-anesthesia care
unit in good condition.

Postoperative management:

 Keep the patient NPO for today then the patient can start sips of water from tomorrow and he should
follow his diet plan provided.
 Keep the patient on Intravenous fluid in form of D5NS at a rate of 150 ml/h and stop as the patient is
tolerating orally.
 Ambulate the patient as early as possible.
 Teach the patient how to use incentive spirometry and Encourage its usage.
 Analgesia :
o Injection Perfalgan 1G Intravenous QID.
o Injection pethidine 75 mg Intramuscular TID PRN for severe pain.
 Antibiotics (no need)
 GI prophylaxis:
o Injection Pantoprazole 40 mg Intravenous once daily.
 DVT prophylaxis:
o Keep the patient on pneumatic compression while on bed.
o Keep the patient on injection Clexane 40 mg Subcutanouse once daily.
 Antiemetic:
o Keep the patient on ondansetron 8 mg IV TID PRN if nausea or vomiting.
 Other medications:
o Give the patient two doses of dexamethasone 8 mg IV.
o Give the patient one dose of neurobion injection Intramuscular before discharge.
 Give the patient his diet plan and illustrated it to him/her.
 Monitoring of pulse, blood pressure, respiration, temperature and urine output.
 Surgical drain care as follow ( if there is any ):
o keep drain on negative pressure.
o monitoring of its output including, color, amount