Laparoscopic sleeve gastrectomy is one of the popular procedure performed in morbidly obese patients to achieve significant weight loss upto 80%. We are explaining golden tips to perform safer sleeve gastrectomy surgery from surgeons perspective.

1. Laparoscopic Sleeve Gastrectomy
Golden Steps
Dr. Deep Goel, FACS (USA), FRCS (England)
Director
Department of Surgical Gastroenterology, Bariatric & Minimal
Access Surgery
BLK Super Specialty Hospital
New Delhi, India

3. Positioning
• Supine / Split leg

4. Port Placement
12
3 4
5

5. Liver Retraction
• Proper liver retraction for adequate view
of GE junction

6. Greater Curvature Mobilization
• Starting from mid body- up and down
• Remain close to stomach wall
• Congenital posterior adhesions

7. Short Gastric Vessel
• Harmonic
• Enseal
• Clip

8. Fundal Mobilization
• Complete mobilization
• Visualize left crus

9. Staple Fire
• First staple fire 2-4 cm from pylorus
• Avoid narrowing at incisura
• Avoid excessive traction on tissue while stapling
• Stapler should go to the tissue rather getting tissue to
the stapler
• Check the angle for loose staples and tissue
• Clean the crotch of stapler before changing cartridge

10. Choice of Cartridge
• Green
• Gold
• Blue

11. Gastric Calibration Tube (GCT)
• 36 French Vs UGI endoscope 28 French

12. Excise Complete Fundus
• Landmark
–Belsy’s fat – medial / lateral

13. Leak Test
• Air insufflation test
• Methylene blue test

14. Staple Line Bleed
• Raise BP 150 mmHg systolic
• Clip
• Suture

15. Bag Vs No Bag
Removal of Excised Stomach

16. • Port site irrigation
• Closure of port

17. Controversies
• Buttress material
• Over-sewing
• Post-op gastrografin study
• Drain

18. Thanks