A Technique for Dealing with the Short Gastric Vessels Near the Upper Pole of Spleen During Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure in metabolic and bariatric surgery worldwide. Despite its technical simplicity, LSG presents challenges, such as the safe division of short gastric vessels and the uniform stapling of the stomach. The division of the short gastric vessels during the mobilisation of the gastric fundus in proximity to the splenic upper pole particularly exposes to the risk of haemorrhage. In case of bleeding, the injured vessel can retract, making any attempts to achieve haemostasis very difficult. In order to perform this dissection safely, some authors suggest using the hepatic retractor as a gastric retractor under the posterior surface of the fundus. Whereas, some other authors suggest using a radio-opaque marked laparotomy pad placed in contact with the spleen to relax the greater omentum. In this video, we show our technique for safe hemostasis of short gastric vessels during the mobilisation of the gastric fundus in proximity to the splenic upper pole.