title: Aortic injuries during laparoscopic gastric bypass for morbid obesity in Sweden 2009-2010: a nationwide survey.
abstract: BACKGROUND
  In Sweden, bariatric surgery has increased more than tenfold in the past decade, from 700 to 8,600 procedures annually, and laparoscopic gastric bypass (LRYGB) dominates (92% of all procedures). This expansion makes safety issues crucial. The aim of this nationwide survey was to identify aortic injuries in LRYGB.
  
  
  METHODS
  All 41 centers performing LRYGB in Sweden were asked if an aortic injury had occurred during the years 2009-2010. Techniques for entering the first trocar and way of establishing pneumoperitoneum were evaluated. The total number of procedures was collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), and the National Patient Register.
  
  
  RESULTS
  During the study period, 11,744 LRYGBs were performed. The analysis revealed 5 aortic injuries, all occurring in patients in whom an optical trocar had been placed before establishing pneumoperitoneum. Outcomes varied from no major sequelae to bilateral lower limb amputation and death. Based on the total number of LRYGBs, the risk for an aortic injury was .043% overall and .091% when an optical trocar was used.
  
  
  CONCLUSIONS
  Aortic injury is a rare but serious complication in laparoscopic gastric bypass. In this survey, optical trocars constructed to reduce the risk of intraabdominal damage had been used in all 5 cases.
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. Electronic address: magnus.sundbom@surgsci.uu.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sundbom
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Jakob
authors.initials: J
authors.lastname: Hedberg
authors.affiliation: Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Wanhainen
authors.affiliation: Department of Surgery, Örebro University, Örebro, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Ottosson
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D057772:Vascular System Injuries / Q000453:epidemiology*
keywords: Aortic injury; Gastric bypass; Laparoscopy; Optical trocar; Trocar injury