The visualization of gastro-esophageal junction vascular supply during a laparoscopic sleeve gastrectomy. Role of a new device.

Leaks arising at the level of gastro-esophageal junction remain a major complication in patients who undergo a laparoscopic sleeve gastrectomy. Besides technical pitfalls, these fistulas are mainly attributable to tissue ischemia following the preparation of the gastric sleeve, explained by the irregular vascularization often present in the area of the gastro-esophageal junction. This video presentation shows how, the utilization of a new model of bougie can be of help in preventing a leak, allowing a better visualization of the particular vascular anatomy present at the level of the gastro-esophageal junction area. Currently, 25/334 (18 F-7 M) (7.4%) patients, who underwent a laparoscopic sleeve gastrectomy at our institution, were operated on using this new model of bougie. No leaks have been so far reported.