Abstract:

The operation was performed with a three-hole laparoscope. After liver suspension and simple exploration, the patient had more visceral fat deposition. From the opposite side of angular incisure to greater curvature of stomach, cut off the greater omentum by the stomach wall’s greater curvature side. Starting from the greater omentum, dissociate downward to 3cm above pylorus (comparing with 5cm sutures) and continue toward to the head side. The short gastric arteries was cut off by the stomach wall and the His angle was exposed. Opening the peritoneum at His angle and dissociating or partial excision the Fad Pad in front of EGJ in order to fully expose the left margin of EGJ. A 36-Fr bougie was placed to or pass the pylorus orally and pushing it to the lesser omentum side. From the 4 or 5cm above pylorus, most of the gastric tissue was dissected vertically along the Bougie tube by stapling device until 0.5~1 cm outside the left edge of the EGJ. The proximal pyloric tissue is thicker so three rows of varied height staplers were used. Adequate reduction of gastric tissue volume is necessary due to the presence of satiety associated pressure receptors and gastrointestinal hormone secreting glands. Finally, under endoscopy, V-Loc string was used to cover the stump, so that the cutting edge was fully folding. Minimizing anastomotic fistula-a rare but serious complication.

Key words: Obesity, Metabolic and bariatric surgery, Laparoscopic sleeve gastrectomy