Surgical technical key points of laparoscopic sleeve gastrectomy: how I do it

Laparoscopic sleeve gastrectomy (SG) is one of the most performed bariatric operations worldwide, often surpassing the traditional laparoscopic Roux-en-Y gastric bypass, mainly because it is a faster and less complex procedure when comparing both surgeries. However, the lack of technical standardization can influence outcomes. The relationship between weight loss, weight regain, and gastroesophageal reflux disease (GERD) after laparoscopic SG is very controversial and may be related to technical variations, such as the esophagus gastric junction (EGJ) dissection, stapling distance from esophagus and pylorus, bougie calibration and oversewn of the pouch. All these variations are related to the final tube shape and may influence results. Learning with videos of experts can be an important tool as it allows remote learning and has the power to further dissemination and democratization of the knowledge and techniques of specialists in the field, avoiding mistakes that can occur with the learning curve of new bariatric surgeons. Video learning is cheaper and can reach a greater number of surgeons at the same time, sparking discussions and accelerating the evolution of the technique. The aim of this study is to present technical key points and pearls that should contribute to standardizing the procedure and improving outcomes.