Because there is typically less visceral fat in the upper abdomen of these patients, most large livers can be adequately retracted. These patients usually have a large omentum from the visceral fat lower in the abdomen, which can be avoided during sleeve gastrectomy. However, the omentum is still a surgical factor with the gastric bypass because of the need to perform a jejunojejunostomy (ie, jejunum to jejunum anastomosis)