Sleeve gastrectomy (SG) is a surgical procedure that involves a significant reduction in stomach volume, resulting in a tubular-shaped conformation of the stomach. Despite its relative simplicity, it is not easy to construct a “perfect” sleeve. Adherence to a routine and proper technique, as the surgical steps outlined in this chapter, is essential for a low incidence of complications, proper durable weight loss, and avoiding high incidence of postoperative GERD.