A639 Salvaging sleeve staple line after removal of an incorporated temperature probe

Stapling of a bougie, temperature probe, or a nasogastric tube is a rare and poorly reported complication of bariatric surgery that can lead to significant morbidity in patients. The best management of such a complication is unclear. Patient is a 55-year-old gentleman with a BMI 35 kg/m2, hypertension, type 2 diabetes mellitus and obstructive sleep apnea. Patient underwent a laparoscopic sleeve gastrectomy using a 34Fr Bougie. At the end of the case, attention was brought to the fact that the tip of the oral temperature probe was missing. The specimen was examined and revealed the tip within the resected stomach. The staple line was inspected and revealed a defect with a small amount of adherent clot. There was found to be a loose staple, which was removed. The defect was repaired primarily with a Figure-of-eight suture and imbricated with Lembert sutures. Care was taken to avoid excessive narrowing of the stomach. An intraoperative leak test and esophagogastroduodenoscopy were performed to confirm that there was no leak. An upper GI study on post-operative day one revealed no leak. Patient was started on a clear liquid diet and discharged on post-operative day 2. On 30-day follow up, patient was tolerating a puree diet without dysphagia with a total weight loss of 21 lbs and resolution of hypertension and diabetes.