My name is Franze de la Calle, and I am currently completing my advanced clinical rotation at NYP-Queens. These past months have been exciting. I am noticing that as the days go by, I don’t doubt myself as much, and although I am still building my skills, I am more confident when I interact with patients and when I make my nutrition recommendations.
One of the most exciting experiences that I have had so far has been to observe a Laparoscopic Sleeve Gastrectomy (LSG), or sleeve gastrectomy, live. The LSG is performed laparoscopically to remove ~80% of the stomach. It was mind-blowing to see the surgery from beginning to end. Beforehand, the surgeons sketched-out and walked me through the procedure, which helped me understand the surgery while I observed.
The ambiance of the room was relaxed and casual, especially since the surgeons played Bob Marley the entire time! It was impressive to see the surgeons’ dexterity with the surgical instruments, too. As you can imagine, surgeons need to be very precise and extremely careful as they sever the tissue. This is especially true as they approach the splenic artery to prevent splenic ischemia. Although LSGs are fairly easy and quick surgeries, during the occlusion of the gastric-splenic vascular supply the spleen can easily necrotize due to bleeding. In fact, I found out that splenic injury, which I saw happening in this patient, is a common risk of this type of bariatric surgery. In general, splenic infarcts occur more often in the area where the spleen is attached to the fundus of the stomach because this area is more challenging for surgeons to dissect, as the tissue is more firmly connected. For this patient, the surgeons had to cauterize and staple the segment of the head of the spleen called the Upper Splenic Pole to stop the hemorrhage. The cauterization along with the bleeding led to infarction of about 30% of the patient’s spleen.
I also had the opportunity to observe the air leak test for staple failure, which not all surgeons do. The procedure is simple, and it involves inflating the cut-out segment of the stomach with air, like a balloon, after it has been removed from the abdominal cavity to detect air leaks. Gastric leaks are a more common complication (~5% incidence) in LSGs that in other bariatric surgeries because Sleeves are vertically oriented gastrectomies that require forming of a long staple line. In general, the staples for LSGs measure approximately 60 mm in length. For this patient, six staples were used, forming a 14-inch staple line. Fortunately for this patient, the staple line was adequately sealed, with no leaks present. However, leaks are associated with increased risk in mortality in this population as they can appear postoperatively.
Having observed the sleeve gastrectomy has expanded my appreciation for the resiliency and adaptability of our digestive system. As I dive further into my advance rotation and prepare for my MNT concentration, I look forward to having additional opportunities to deepen my knowledge and confidence.
One of the most exciting experiences that I have had so far has been to observe a Laparoscopic Sleeve Gastrectomy (LSG), or sleeve gastrectomy, live. The LSG is performed laparoscopically to remove ~80% of the stomach. It was mind-blowing to see the surgery from beginning to end. Beforehand, the surgeons sketched-out and walked me through the procedure, which helped me understand the surgery while I observed.
The ambiance of the room was relaxed and casual, especially since the surgeons played Bob Marley the entire time! It was impressive to see the surgeons’ dexterity with the surgical instruments, too. As you can imagine, surgeons need to be very precise and extremely careful as they sever the tissue. This is especially true as they approach the splenic artery to prevent splenic ischemia. Although LSGs are fairly easy and quick surgeries, during the occlusion of the gastric-splenic vascular supply the spleen can easily necrotize due to bleeding. In fact, I found out that splenic injury, which I saw happening in this patient, is a common risk of this type of bariatric surgery. In general, splenic infarcts occur more often in the area where the spleen is attached to the fundus of the stomach because this area is more challenging for surgeons to dissect, as the tissue is more firmly connected. For this patient, the surgeons had to cauterize and staple the segment of the head of the spleen called the Upper Splenic Pole to stop the hemorrhage. The cauterization along with the bleeding led to infarction of about 30% of the patient’s spleen.
I also had the opportunity to observe the air leak test for staple failure, which not all surgeons do. The procedure is simple, and it involves inflating the cut-out segment of the stomach with air, like a balloon, after it has been removed from the abdominal cavity to detect air leaks. Gastric leaks are a more common complication (~5% incidence) in LSGs that in other bariatric surgeries because Sleeves are vertically oriented gastrectomies that require forming of a long staple line. In general, the staples for LSGs measure approximately 60 mm in length. For this patient, six staples were used, forming a 14-inch staple line. Fortunately for this patient, the staple line was adequately sealed, with no leaks present. However, leaks are associated with increased risk in mortality in this population as they can appear postoperatively.
Having observed the sleeve gastrectomy has expanded my appreciation for the resiliency and adaptability of our digestive system. As I dive further into my advance rotation and prepare for my MNT concentration, I look forward to having additional opportunities to deepen my knowledge and confidence.
