Background

Sleeve gastrectomy has become increasingly popular worldwide; Controversy exists regarding the ideal bougie and the technique is not standardized. The 'best sleeve' has been described as a trapezoidal shape with a narrowed top by the LES. We propose a surgical technique that respects patient anatomy and the Gastric Canal (Megenstrasse) by following the lesser curvature vessels without the guidance of a bougie.

Methods

Robotic Sleeve Gastrectomy was performed with resection starting approximately 3 cm proximal to the pylorus. The stomach is stapled along the end of the lesser curvature vessels up to the Angle of His using buttressed staples. Extreme care is taken to respect the angulation of the incisura and the resection is completed lateral to the GE junction fat pad.retrospective review data of a single surgeon performing robotic Sleeve Gastrectomy using this technique between Jan 2021 to March 2023. 221 patients (176 women and 45 men) were analyzed. Mean age was 40 years. Mean preoperative weight was 121.44 kg. Mean preoperative BMI was 43.9 (. Mean operative time 90 minutes.The average length of stay was 1.4 days. Weight loss was on trend at 6 months and one year post-operatively utilizing comparison of BMI reduction through aggregated programmatic data of participating MBSAQIP centers.

Conclusions

Standardizing sleeve gastrectomy by following the ''end of the vessel'' technique offers a standardization of the surgical technique following a patient-centric rather than a bougie-centric approach . It is safe and produces similar weight loss compared to published data.