search
Patient Preparation and Port Placement
Modified lithotomy position. Aseptic preparation. Supraumbilical 20 mm transverse incision to access and remove gastric band port and capsule. Peritoneal entry and placement of 12 mm trocar; creation of pneumoperitoneum (12 mmHg CO₂). Placement of additional trocars: one 12 mm (right flank), two 5 mm (left flank), and Nathanson liver retractor.
Band Identification and Removal
Identification of gastric band with thickened capsule. Dissection and mobilization of capsule using harmonic scalpel. Sectioning of connecting tube and complete removal of the band without complications.
Gastric Capsule Dissection
Continued dissection of perigastric capsule from inferior border in cephalad, lateral, and posterior directions to fully expose the gastric wall and gastroesophageal junction.
Greater Curvature Mobilization
Creation of window through gastrocolic omentum at lower greater curvature. Dissection with harmonic scalpel towards short gastric vessels, which were divided to mobilize gastric fundus and body up to angle of His. Mobilization continued distally up to 3 cm from pylorus.
Posterior Gastric Dissection
Lysis of posterior adhesions with laparoscopic scissors to achieve complete gastric mobilization. No hiatal hernia identified.
Sleeve Gastrectomy and Stapling
Insertion of 32 Fr orogastric calibration tube. Stapler positioned 5 cm from pylorus along greater curvature. Initial stapling with 60 mm GI cartridge (1.6 mm), followed by sequential firings with 60 mm GI cartridges (1.4 mm) toward angle of His, maintaining calibration.
Final Staple Line and Reinforcement
Final stapling completed 1.5 cm distal to angle of His using blue cartridge. Continuous seromuscular Lembert suture (2-0 polypropylene) applied along staple line for reinforcement and hemostasis.
Leak Test and Hemostasis
Trendelenburg position. Submersion of gastric sleeve in saline and insufflation with oxygen (2 L/min). No air leaks detected. Irrigation and aspiration performed.
Specimen Retrieval and Closure
Insertion of specimen bag. Removal of resected stomach through initial incision without spillage. Trocar and CO₂ removal. Fascial closure with 0 polypropylene sutures; skin closure with subcuticular 3-0 poliglecaprone 25 and Dermabond adhesive.
Closing remarks
