Sleeve Gastrectomy in a Severe Obesity Patient

Case Record:

44 y.o. patient  diagnosed with morbid obesity. The patient has an BMI of 51 with no symptoms of gastroesophageal reflux disease. The patient was proposed for bariatric surgery and a sleeve gastrectomy was performed. 

Clinical History:

• 44 y.o. female patient diagnosed with morbid obesity, with a BMI of 51.

• Associated comorbidities: Type 2 Mellitus Diabetes treated with oral anti diabetic drugs and hypertension

• No clinical gastroesophageal reflux disease 

• Proposed for a sleeve gastrectomy

Procedure Steps:

1. Patient in supine position, open arms and legs, reverse Trendelenburg

2. Pneumoperitoneum creation

3. Laparoscopic ports placement

4. Marking of the inferior point of the dissection, 5 cm from the pylorus in the greater curvature

5. Dissection of the omentum

6. Revision of retro gastric surface

7. Introduction of a 32 French bougie for gastrectomy calibration

8. Transection the stomach with Panther 60 mm

9. Stapling line coagulation control with hemo-clips

10. Epiplon fixing to the remnant stomach

11. Extraction of the removed stomach

12. Closure of ports incisions

Learning Points:

1. Correct selection of the point for starting dissection

2. Liberation of the His Angle

3. Stapling line hemostatic control

4. Selecting the correct endostapler