Lap Adjustable Gastric Banding Operative Sample Report
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Morbid obesity, body mass index 42.
2. Hypertension.
3. Hypercholesterolemia.
4. History of cerebrovascular accident.
5. Obstructive sleep apnea.
6. History of repair of patent foramen ovale.
POSTOPERATIVE DIAGNOSES:
1. Morbid obesity, body mass index 42.
2. Hypertension.
3. Hypercholesterolemia.
4. History of cerebrovascular accident.
5. Obstructive sleep apnea.
6. History of repair of patent foramen ovale.
PROCEDURES PERFORMED:
Lap adjustable gastric banding using a 10 cm, 4.5 mL capacity band.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
BLOOD LOSS: Nil.
SPECIMEN: None.
INDICATIONS FOR PROCEDURE: This is a pleasant (XX)-year-old woman who presents for lap gastric banding surgery. She has attempted multiple nonsurgical weight loss plans but had not been successful. She now desires a more permanent weight loss solution using lap gastric banding surgery. We met with her on two separate occasions and discussed the procedure as well as the risks and complications associated with it. She has had a complete medical workup, and all of her questions have been answered regarding lap adjustable gastric banding.
DESCRIPTION OF PROCEDURE: The patient was brought into the operating room, placed in the supine position, and given anesthesia for lap adjustable gastric banding. A left upper quadrant stab incision was created. Veress needle was inserted. Pneumoperitoneum was instilled to pressure of 15 cm of water. A 12 mm port was placed in the supraumbilical area, 15 mm port in the left midclavicular line, and 5 mm ports in the right upper and left lower quadrants.
A small stab incision was created at the xiphoid, and the left lobe of the liver was retracted up and out of the operative field with a locking grasper. The angle of His was dissected bluntly and the left crux of the diaphragm was fully visualized. The pars sellaris was then divided and the right crux of the diaphragm was followed down to its base. A blunt instrument was passed behind the esophagus, was exited at the angle of His at the base of the left crux of the diaphragm.
A size 10 cm, 4.5 mL capacity lap band was chosen. It was primed and placed into the peritoneal cavity through the 15 mm port. The tubing was grasped and brought behind the esophagus. It was then placed through the buckle of the band. The band, however, was not locked. The sizing balloon was placed down and 20 mL of air was placed in the balloon. It was drawn up against the GE junction and the GE junction was identified. The band was then locked. The balloon was let down and drawn back into the esophagus. The fundus of the stomach was then fixed to the cardia of the stomach using 0 Ethibond sutures. A total of three sutures were placed, beginning at angle of His posteriorly and extending up to and including the buckle of the band. A fourth suture was placed across the anterior stomach below the band to minimize any chance of anterior slippage.
The sizing balloon was then withdrawn. The instrument passed alongside the band quite easily. There was no sign of obstruction. The tubing was then grasped and brought out through the midclavicular line ports, and all ports were withdrawn. The liver retractor was withdrawn. No bleeding was noted. A pocket was then created on the anterior abdominal wall between the fascia and the subcutaneous fat. The port was fixed to the tubing, and the port was then fixed to the anterior abdominal wall with #0 Prolene sutures. The tubing was placed back in the peritoneal cavity without any evidence of kinking or twisting.
The wound was irrigated. Local anesthetic was instilled. Subcutaneous layer was closed with 2-0 Vicryl. The skin was closed with 4-0 Vicryl subcuticular sutures. Steri-Strips and dry sterile dressings were applied. There were no complications.
