Editing Sleeve gastrectomy (section)

== '''Consensus on technique is highly dynamic''' ==

* "The first modified     Delphi consensus statement on sleeve gastrectomy" for further reading


'''Technique'''

* Optical 10mm entry just to     left of midline midway between umbilicus and xiphoid. 10mm Palmer's point,     12mm RUQ, 5mm LUQ, 5mm for Nathanson (just trochar to make this port)
* Retract liver with Nathanson
* Make window into lesser sac     through gastrocolic ligament, right at inferior edge of stomach, about     halfway along greater curvature
* Carry this division along to     the angle of His, staying right on the stomach, dividing short gastrics     along the way
* Now also free the greater     curvature back about 5cm proximal to pylorus (go to the point where the     stomach starts to widen, because this will be your initial stapling point,     and you want to make a nice smooth tube with consistent width)
* Start stapling the stomach.     Green load for first one, then blue for subsequent loads.
** Initially just keep the      stomach tube a consistent length until the incisura is passed, then use      bougie
** Want to make a nice straight      line towards the angle of His/inferior phrenic artery once the incisura      is passed
** Avoid twisting or spiralling      of the gastric tube
** Preserve left gastric      vessels and lesser curve blood supply
** 34-40Fr bougie placed in      stomach after the incisura is reached, directed along lesser curve      (Craven uses 36Fr)
*** Smaller bougie gives higher       chance of GORD, and larger is associated with weight regain
* Suture omentum back onto     staple line with interrupted, then can use some glubran on top
* Remove resected stomach via     RUQ port
* Don't close fascia
* Monocryl to skin