Laparoscopic sleeve gastrectomy: Paying attention to the detail

As reported by the last IFSO worldwide survey on bariatric surgery, sleeve gastrectomy became the second most performed bariatric/ metabolic procedure in the world just after gastric bypass. Sleeve gastrectomy had a wide diffusion probably due to the easy surgical technique, although it must not be considered safe from complications, which can be severe and even life-threatening. Technical tips, and standardization of the procedure are required in order to minimize complications such as gastric leaks, stenosis and bleeding. To ensure high quality standard of this surgical treatment, dissection and resection should be done using appropriate technology. The aim of this review is to present various technical aspects and tips reported in literature in order to optimize the surgical procedure in safety and effectiveness. In particular we focused our attention to trocars positioning, dissection of the greater curvature, dissection of the angle of His, bougie caliber, application of the stapler and haemostasis.