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Sleeve gastrectomy
> Dissection
> Linear Gastrectomy
> Postoperative Management

In case of high risk patients, the sleeve is used as a first Stage to induce weight reduction allowing for the more demanding intestinal dissection to be performed under good condition.

In the sleeve gastrectomy, trocars are placed as for a gastric bypass

Dissection

The stomach is lifted and the surgeon starts the devascularisation of the greater curvature with the help of the Ultracision _ device. Once the lesser sac has been entered, dissection is continued in a cephalad direction and the lower pole of the spleen is quickly reached.
At the level of the spleen’s lower pole, the peritoneal sheets are farther apart and the tissue in between is thicker and harbours tortuous vessels (the short gastrics) which must be coagulated separately, by using small bites of the Ultracision.
Eventually the dissection reaches the root of the left pillar of the hiatus.
When the upper pole of the fundus has been freed, the surgeon can lift the stomach anteriorly and to the right very much like turning a page of a book
Care should be taken not to damage the left gastric vessels which in an obese patient are always closer (lower) than one would anticipate. Once the stomach has been freed, division can be performed.