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M AY 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
and fewer complications. All these factors make performing the pro-
cedures in a freestanding ASC reasonable and safe. In fact, we've
been hosting the procedure for years at our freestanding ASC in the
Seattle suburbs. Here are 3 keys to our success.
1. Patient selection
Patients who weigh more than the upper limits of OR tables (450 lbs. at
our facility), have general immobility that prevents early post-op ambula-
tion and present with complicated anatomy that would likely extend sur-
gery beyond 2 hours, are not ideal candidates for outpatient LSG. We
also exclude patients with comorbidities such as cardiac and pulmonary
issues who'd require longer than an overnight stay.
Patients with scores of 2 or higher on the STOP-BANG sleep apnea
screening tool must undergo a sleep study before being cleared for sur-
gery. Patients who meet national guidelines for pre-op cardiac evalua-
tions must undergo extensive cardiac screenings, and those with hypoxia
or chronic metabolic alkalosis must undergo screening for pulmonary
hypertension.
2. Perioperative precautions
Before surgery, patients are placed in the supine position, with a
wedge positioner placed behind their backs to improve access to the
upper abdominal cavity. Two bariatric surgeons perform the procedure
through 5 ports, with the primary surgeon standing to the patient's
right. Anesthesiologists experienced in sedating bariatric patients have
quick access to difficult airway management tools, including fiber-optic
scopes and video laryngoscopes.
I cannot over-emphasize the importance of having an experienced
bariatric surgeon and an entire bariatric team well-versed in sleeve gas-
trectomy. Our operative times are routinely less than an hour.
B A R I A T R I C S U R G E R Y
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