There are multiple technical approaches to performing a laparoscopic sleeve gas­trectomy (LSG) with countless variations [1–4]. I put together a description of my approach after 2500 consecutive procedures. I modified this approach over the past 10 years and standardized it 5 years ago with the intent of balancing the weight loss aspect of the procedure along with reduction in complication poten­tial. Now that we understand LSG not only as a restrictive but also satiety-reducing procedure, we put more emphasis on complete excision of the fundus and do not necessarily make the gastric tube too tight [5, 6]. We are also cognizant of the del­eterious effect of reflux esophagitis on patients long-term so we emphasize the need to detect and repair hiatal hernias intra-operatively with tight crural repair [2, 7]. Reflux esophagitis results not only from hiatal hernias but more likely from any anatomic or functional gastric obstruction. That is why it is important to avoid twists or narrowing particularly at the Angularis Incisura [1, 8]. Bleeding and staple line leak remain the two most common short-term complications of LSG. Choosing the appropriate staple line height, over sewing or re-enforcing the sta­ple line and avoiding gastric tube narrowing are all key technical elements that reduce these risks [9]. Lastly, we routinely fix the gastric tube to the transverse colon mesentery at the inferior border of the pancreas to minimize the risk of axial torsion and perhaps provide a form of fixation of the stomach in the abdomen to reduce of risk of intra-thoracic migration [10].