FormalPara Purpose

Controversial features related to SFG are (1) sleeve size and volume, (2) prevention of esophageal gastric junction (EGJ) leaks and (3) size of the antrum. We have used subtotal antrectomy in more than 1350 isolated GS or duodenal switch and reported [1, 2] suturing the staple line to reduce leaks.

FormalPara Technique

Six ports lap ports are used. A silk suture is passed around the round ligament to lift the liver. Gastric devascularization reaches the EGJ proximally and 2 cm distal to the pylorus to allow its full mobility.

A 12-mm boogie is placed along the lesser curvature. The stomach is divided starting 1 cm proximal to the pylorus and up to the EGJ with 6-cm long blue cartridges, and 85 % of the stomach is removed (Fig. 1). The GS diameter is smaller than the esophageal lumen (Fig. 2).

Fig. 1
figure 1

Subtotal antrectomy

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Fig. 2
figure 2

X-rays studies on four different gastric sleeves

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The staple-line suture includes the greater omentum and both gastric walls with continuous Surgipro 2/0 suture and C-22 needle. A Lembert-type suture starts with a sliding self-locking first stitch and ends with an Aberdeen knot [3, 4].

Leak test is done, the stomach is removed, and the fascia opening is closed with Maxon double suture.

The advantages are the following: (1) reduce the GS volumes by the antrectomy, (2) prevent bleeding and leaks, (3) the “omental patch” covers the staple line if a leak occurs, and (4) prevention the GS rotation.

FormalPara Results

Mean OR time is 54 min (42–146 range). One leak occurred in 163 cases after the omental patch technique. Mean %EBMIL is 76 % (64–121 %) at 1 year.

FormalPara Conclusions

(a) The omental patch on the suture line is cheaper than any other reinforcement, and it may decrease leak and bleeding rates and (b) a very narrow tube covered with the omentum plus the subtotal removal of the antrum decreases gastric volume, and weight losses are excellent.