Background

Patient is a 52-year-old female with a history of hyperlipidemia, gastroesophageal reflux disease, and morbid obesity, who had previously undergone a laparoscopic sleeve gastrectomy who presented to our clinic with weight regain (body mass index of 42) and worsening reflux symptoms. Pre-operative esophagogastroduodenoscopy revealed narrowing at the incisura with proximal gastric dilation, a hiatal hernia, and evidence of bile reflux. The patient was taken to the operating room for a robotic assisted laparoscopic conversion of sleeve gastrectomy to Roux-en-Y gastric bypass. Unfortunately, during the operation, a splenic hilar vessel was injured causing significant blood loss. This video demonstrates a minimally invasive approach for the management of splenic hilar bleeding which included perisplenic packing and suture ligation of hilar vessel with robotic assistance. The patient had an uneventful recovery, did not require conversion to open or transfusion of blood products, and was discharged on postoperative day 2. The patient was last seen at 30 months post-op and was doing well.