Abstract
A 44-year-old superobese woman with a body mass index of 62 kg/m had achieved 24% excess weight loss fter the insertion of 2 sequential intragastric balloons (BIB, llergan, Irvine, CA). Her body mass index had decreased rom 62 to 53 kg/m within 1 year. Definitive sleeve gastrectomy was planned. The intragastric balloon was removed intraoperatively using an endoscopic approach. Then, stapled laparoscopic sleeve gastrectomy was begun 5 cm proximal to the pylorus on the greater curvature of the stomach. A 34F orogastric tube was used to size the sleeve. The first firing with the ETS Endoflex 45-mm, green staple cartridge (Ethicon, Memphis, TN) failed to close the stomach wall. The procedure was completed using hand-sewn sutures, with a midline laparotomy. The gastrectomy was successfully completed up to the angle of His with consecutive firing of the green staple cartridges. The orogastric tube was removed, and methylene blue testing revealed no leaks. On the second postoperative day, a water-soluble contrast study demonstrated contrast passing into the proximal
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