Consent: Sleeve Gastrectomy

Original Author: Ollie Jones
Last Updated: February 14, 2019
Revisions: 5

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

A sleeve gastrectomy procedure primarily works via a restrictive mechanism, whereby the greater curve of the stomach is removed leaving only a tube ~4-5cm wide.

Figure 1 – A sleeve gastrectomy

Complications

Intra-Operative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage The liver is very vascular and may bleed, as well as any other surrounding structure.
Injury to surrounding structures including bowel, bladder and ureter, liver, spleen Damage can occur to any surrounding organ during the surgery.
Anaesthetic Risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications. Forms a part of the anaesthetist assessment before the operation

Early

Complication Description of Complication Potential Ways to Reduce Risk
Infection Superficial wound infection or intra-abdominal collections are both possible as is chest infection due to the body habitus and reduced mobility of these patients. Early mobilisation, breathing exercise, or incentive spirometry can help
Leak from the staple line (1 in 25) Leakage from the staple line may occur.  As with any anastomotic leak, this is potentially serious and frequently requires further surgery, tube feeding and a prolonged hospital stay
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer, and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery; the mortality risk is around 1 in 500

Late

Complication Description of Complication Potential Ways to Reduce Risk
Metabolic and endocrine disturbances This is potentially life-threatening. Changes to absorption and gastric secretions of the alimentary canal can affect nutrition considerable post-operatively The involvement of a specialist bariatric dietician in the management of bariatric patients is essential
Failure to lose weight or weight regain Sleeve gastrectomy is highly effective, but inevitably a minority of patients ultimately fail to lose or regain weight.

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