Nissen Sleeve Gastrectomy

Clinical History:

• Female
• Age: 45 years old
• BMI: 41kg/m²
• Apnea Syndrome
• Upper GI: Severe Esophagitis

Technique description:

• 1. Releasing the lower part of the esophagus and treating a potential hiatal hernia
• 2. Creating a Nissen fundoplication
• 3. Performing a sleeve gastrectomy below the fundoplication

Procedure Steps:

• 1. Releasing the left crus and greater curvature of the stomach
• 2. Releasing the lesser omentum and the right crus
• 3. Releasing 5cm of esophagus
• 4. Creating a 360º fundoplication calibrated by a midsleeve tube
• 5. Stapling the stomach (6cm from the pylorus to the left of the fundoplication)
• 6. Checking with the good shape of the Nissen sleeve with the midsleeve tube
• 7. Controlling the vascularization of the wrap with ICG

Learning Points:

• Fixing the fundoplication above the GE Junction
• Calibrating the fundoplication with a tube (36F)
• Transecting the fundus with only one layer of the gastric wall to the left of the wrap
• Checking the lack of gastric stenosis at the level of the wrap with the gastric tube