Exploring  Alternative  Techniques  for  Laparoscopic  Sleeve  Gastrectomy  with  Stapling  First:  the  In  Situ  Method

Introduction: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed procedure in metabolic and bariatric surgery (MBS) worldwide. Despite its technical simplicity, LSG presents challenges, such as the safe division of short gastric vessels and the uniform stapling of the stomach. This study introduces a modified approach to LSG termed the 'in situ' method, and reports its outcomes. Materials and Methods: A retrospective analysis was conducted on data from patients who underwent LSG using the in situ method between December 2019 and January 2022. Patient demographics, perioperative profiles, early postoperative complications, and one-year postoperative weight loss outcomes were collected. Results: Among 1038 primary procedures, 668 cases of LSG were analyzed. The mean age was 34.57 ± 9.90 years, with a mean preoperative BMI of 37.87 ± 5.02 kg/m². Major postoperative complications occurred in 1.2% of cases, with a bleeding rate of 1.0% and a leakage rate of 0.1%. No cases of sleeve stenosis were reported. Weight loss outcome at one-year showed BMI loss of 11.08 ± 3.84 kg/m² and %TWL of 28.67 ± 7.94 %. Conclusion: The in situ method is a safe and feasible approach for LSG, allowing for the safe division of short gastric vessels and uniform stapling. ⮚ The in situ method consists of applying the stapler first and subsequently transecting the short gastric vessels in a retrograde fashion. ⮚ The in situ method demonstrated comparable outcomes to the conventional approach in LSG. ⮚ The in situ method allows for the safe division of the short gastric vessels and the execution of uniform stapling on both sides of the stomach with ease.