**Figure 14.**

*Specimen removal with a jaws grasper.*

*3.1.10 Closure of Trocar sites*

The 15- and 10-mm trocar fascial defects are closed with a suture passer.

**Pitfall:** If not repaired, trocar site hernias may occur, mainly due to 15-mm fascial defects (**Figure 15**).

*Laparoscopic Sleeve Gastrectomy – Technical Tips and Pitfalls DOI: http://dx.doi.org/10.5772/intechopen.108997*

**Figure 15.** *Fascial closure with a suture passer device.*

#### **3.2 Early postoperative care**

It is critical to resume analgesics and antiemetics in the recovery unit. To prevent vomiting or retching, aggressive nausea prevention and early mobilization are provided. The combination of antiemetics such as ondansetron and metoclopramide with multimodal analgesia is effective.

In our practice, patients are mobilized 2–4 hours after surgery. After the anesthetic drugs have worn off, small sips of water are taken. Clear liquids are usually started on the first postoperative day, followed by a high-protein liquid diet on the second day. The majority of patients are ready for discharge home on the second day. Daily micronutrient supplements are required due to inadequate dietary intake. Anticoagulation prophylaxis is provided for 2 weeks after discharge. A proton pump inhibitor is recommended for 3 months.

Many obese patients have OSA, and if their personal device is present, it is safe and preferred. However, some may require continuous pulse oximetry and positive airway pressure in the ICU following surgery.

CRP levels and complete blood count are highly correlated with postoperative complications and can be taken every 24 hours.

The postoperative diet is varied. Usually, practices begin with clear liquids, increasing the volume gradually. Intake should be in small portions. The daily intake goal is 2 L. If the patient tolerates this, liquid foods such as milk and yogurt can be safely started without delay. After 1–2 weeks, patients progress to a mashed or pure diet. It is recommended to separate liquids from solids. After 2 weeks, patients can start a soft diet. The solid foods are started at 1 month [7].

### **4. Summary**

Although LSG can be performed with different technical methods at various stages, to avoid postoperative complications and obtain the best weight loss results, it is necessary to pay attention to the following key points:

