The suprahepatic approach. An easy laparoscopic access to the hiatus in obese patients

The conventional laparoscopic access to the gastroesophageal junction involves the retraction the left hepatic lobe upward. This approach could be particularly difficult in obese patients because of a huge fatty liver. The technique described here aims to overcome this difficulty be using a suprahepatic route by displacing the left lobe downward after dividing the left triangular ligament. This approach allows a good exposure of the gastroesophageal junction to perform a fundoplication or a gastric banding.