Gastric sleeve fixation strategy in laparoscopic vertical sleeve gastrectomy

Initially conceived as the first of two stages in operations such as gastric bypass or duodenal switch in high-risk patients, laparoscopic vertical sleeve gastrectomy has increasingly become the definitive procedure for treating obesity and its comorbidities. Although it is associated with excellent results and postoperative quality of life, a number of complications related to improper position and/or gastric tube deformities, resulting from loss of natural fixation, may be associated to symptoms of persistent food intolerance and/or gastroesophageal reflux.

To present the gastric fixation strategy in vertical sleeve gastrectomy for the treatment of obesity and related diseases.

The gastric suture line along the "new greater curvature" is divided into two parts. Using non-absorbable 2.0 polyester thread, a continuous suture fixation is made in the proximal part attaching it to the free edge of the gastrocolic ligament with invagination. Separate sutures were applied to the distal part, including the transverse mesocolon near the lower edge of the pancreas.

The stomach fixation strategy is easy to use, safe and can reduce complications arising from improper positioning and gastric tube alterations in laparoscopic vertical sleeve gastrectomy, particularly symptoms related to food intolerance and gastroesophageal reflux.