"Window to Window": A Variant Technique of Laparoscopic Sleeve Gastrectomy.

Abstract

Laparoscopic sleeve gastrectomy (LSG) may present many technical modifications depending on the surgeon. However, no significant variation was noted in the chronological order of the surgical steps in the current technique. We present the "Window to Window," a variant LSG technique. The technique, introduced in our institution in 2007, requires three trocars. Surgical steps, presented chronologically in a descriptive video, start by creating the "paracardial window" then the "antral window." Subsequently, the gastric transection is performed in two phases after progressive retro-gastric liberation. Lastly, the mobilization of greater curvature is carried out followed by specimen extraction and fascial closure. The procedure was performed for approximately 3200 patients and was comparable in terms of medium-term percent of excess weight loss compared with the standard technique. This variant technique of LSG presents many technical advantages for surgeons in terms of safety and exposure compared with the standard technique, while presenting a longer learning curve.