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Aorta and caval perforation during laparoscopic sleeve gastrectomy – a rare complication
Laparoscopic sleeve gastrectomy is a safe and accepted procedure for morbid obesity to reduce weight with an overall low rate of complications; the incidence of major blood vessel injury reported in the literature is 0.1%. In our patient, sudden bradycardia and a fall in blood pressure and oxygen saturation were immediately identified. A camera was inserted and revealed bleeding under the first trocar, necessitating conversion of the laparoscopic procedure to laparotomy. Management included repair of injuries to the aorta and the inferior vena cava by the vascular surgeon, initial supportive therapy with crystalloids, and initiation of inotropic agents and vasopressor drugs. A predefined massive transfusion protocol of red blood cells, fresh-frozen plasma/cryoprecipitate and platelet units (random donor platelets) in each pack in a 1:1:1 ratio was followed.