Self-Locking Sliding Knots in Laparoscopic Bariatric Sutures

Staple suture line reinforcement can be made with different materials. A continuous inverting suture of the entire suture-line, including the omentum, is the best. We use a 12 mm intragastric tube as a guide, and de vascularize all the major curvature vessels, passing from the esophageal ?gastric junction to distal to the pylorus at the duodenal junction. We start the gastrectomy from the pylorus with sequential staplers up to the esophago-gastric junction and routinely try to prevent bleeding and leakage at the staple line with suture reinforcement that includes omentum and the posterior and anterior gastric walls along the entire length of the gastric staple line. The goal of using the already divided omentum along with the suture line is to prevent rotation of the gastric tube.