Anatomic Landmarks in the Sleeve Gastrectomy

BACKGROUND AND OBJECTIVES The vertical sleeve gastrectomy is a common bariatric procedure. The operation is relatively standard, but there are still variations among surgeons. The two main variations are bougie size and extent of distal resection. Some surgeons will start the gastric resection at 2 cm proximal to the pylorus, whereas others start at 6 cm. Our hypothesis is that there are anatomic landmarks that are constant and can be used to help standardize the procedure. METHODS Twenty-eight morbidly obese patients undergoing laparoscopic bariatric surgery (gastric bypass or sleeve gastrectomy) had the distance from the pylorus to the second branch of the right gastroepiploic artery on the inferior border of the greater curvature of the stomach measured. Body mass index, height, weight, age, and sex were also analyzed. RESULTS The study comprised 22 women and 6 men with a mean age of 46.2 years (range, 22-68 years). The mean body mass index was 43.2 kg/m(2) (range, 37.2-62.4 kg/m(2)). The mean distance from the pylorus to the second branch of the right gastroepiploic vessel was 4.52 cm (range, 3.5-5.5 cm). CONCLUSION The second branch of the right gastroepiploic artery can be used as a constant anatomic landmark. It is found about 4.5 cm from the pylorus. This can be safely used as a landmark for marking the distal extent of resection during a vertical sleeve gastrectomy and obviates the need to formally measure the distance from the pylorus.