IBC-Oxford University2023_BJSPoster_1Laparoscopic Sleeve Gastrectomy in a Patient with Severe Haemophilia A

Abstract

Abstract Introduction Haemophilia A is an X linked inherited bleeding disorder caused by deficiency in coagulation factor VIII (FV III). To prevent spontaneous bleeding in muscles and joints, patients with severe Haemophilia A should receive prophylactic replacement therapy with dosing adjusted according to body weight. Case presentation A 19-year-old male patient who is well known to have Haemophilia A, that has been diagnosed shortly after birth during routine circumcision. The patient had presented to our clinic with BMI of 53.9 kg/m2. He was counselled for laparoscopic sleeve gastrectomy after failure of many trials to lose weight. He and his father were counselled for procedure pros and cons. Routine preoperative work up had been performed (Full labs, Abdomen Ultrasound, Dietician consultation, Anaesthesia consultation, Cardiology consultation). Haematological consultation had been done and consultant opinion was to give prophylactic factor VIII 7500 IU: 2 hours prior to surgery, 24 hours after surgery, 72 hours after surgery Extra precaution had been taken in the perioperative period in the form of careful cannulation, IM injections had been avoided completely, no anticoagulants, 1:1 Nursing care, careful patient handling and positioning, continuous monitoring (planned ICU admission for first 24 hours then HDU admission for 48 hours), senior Anaesthetist and senior Anaesthesia technician, on-table gastroscopy, smooth bougie tube placement (size 36F), careful haemostasis by way of slow Harmonic sealing, clipping of short gastrics, 1 minute stapler compression (All green reloads), full stapler line plication and omental patching, maintenance of stable blood pressure during surgery. Patient had an uneventful postoperative recovery, apart from mild bilateral subconjunctival haemorrhages that had subsided spontaneously. Conclusion Laparoscopic sleeve gastrectomy can be performed smoothly in patients with Haemophilia A with proper perioperative multidisciplinary care management.