Why We Think Laparoscopic Sleeve Gastrectomy Is a Good Operation: Step-by-Step Technique

Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the world, with 75% of the primary procedures performed in the United States. It is a safe and effective primary bariatric procedure with good weight loss. When comparing with other procedures, LSG is limited to the stomach, avoiding the presence of internal hernias, preserving the pyloric anatomy, with normal gastric emptying, and conveying less severe rebound hypoglycemia. We describe the technique, step-by-step, we use to perform a sleeve gastrectomy (SG) and analyze why we think it is a good surgery. The highlights of a safer SG systematization are based on minimum 36F bougie calibration, starting 4-5 cm from the pylorus, keeping ∼1 cm distance from esophagus. We routinely use staple line reinforcement by continuous suture. Comparing with Roux-en-Y gastric bypass, less bowel obstruction, less dumping syndromes, less hypoglycemia, and also less ulcers are described. LSG is a safe and effective primary bariatric procedure with durable weight loss. And when comparing with others with intestinal anastomosis, we found fewer complications such as less internal hernias, access to the bile duct after surgery, and has the great advantage that it can be revised when it fails.