Background

Heart failure is one of many severe comorbid conditions associated with obesity. For patients with obesity and advanced heart failure, decisions on weight loss surgery should be made in a multi-disciplinary setting with experience in managing the complex clinical challenges associated with caring for such patients. We present a case in which we encountered unexpected intraoperative hemorrhage during a sleeve gastrectomy in a patient with advanced heart failure and a ventricular assist device. This case provides a review of the general tactics and tools that can be utilized by laparoscopic surgeons to control life-threatening hemorrhage. Furthermore, our video documentation offers insight into the specific technical considerations involved in performing safe laparoscopy in a patient with a left ventricular assist device. The number of patients receiving ventricular assist devices has increased steadily over the past decade, and as we learn more about the clinical outcomes associated with weight loss surgery in this population, cases similar to the one we present here may be encountered more frequently.