Plicated Sleeve Gastrectomy with Combined Mesocolon and Greater Omentum Fixation After T-Shaped Omentoplasty: How to Do it?

Abstract

This technique aims to evaluate fixation of the sleeved distal part of the stomach to the root of the transverse mesocolon and greater omentum after its shortening in a T-shaped design. Sleeve gastrectomy is done in a standard five-port technique. Then, we fix the distal end of the staple line using an inverting interrupted 2/0 Ticron suture. We plicate the anterior and posterior walls to invert the staple line and then fix it to the mesocolic fat below the pancreas and to the edge of the disconnected distal omentum close to the antrum. Proceeding caudally, we shorten the greater omentum in the form of a T-shaped suture that forms an omental window between the two edges of the omentum. Plication and fixation are continued upwards until the lower border of the pancreas. Then, we plicate the sleeved stomach using a 2/0 Ticron suture starting cranially near the angle of His. All patients are discharged from the hospital the next day and followed-up at the clinic after the end of first and second weeks, then after 3, 6, and 12 months postoperatively. Plicated sleeve gastrectomy combined with mesocolon and greater omentum fixation after T-Shaped omentoplasty is safe and feasible. Long-term follow-up study is required to validate our results.