Introduction: Sleeve gastrectomy (SG) has been shown to be an effective first stage procedure for morbid obese patients. We evaluated the effect of the laparoscopic SG (LSG) on excess weight loss over one year followup using a 29 French scope instead of a bougie.

Methods: In our video, we describe a 53-year-old woman with a BMI of 54 who presented with seven different comorbidities. She did not want any intestinal gastric anastomosis; therefore, she underwent a laparoscopic sleeve gastrectomy.

Results: The patient described was sent home one day after surgery. She was able to follow the diet and return to work. She lost 52% of excess weight loss at the first 12 months. In our experience, the first 20 patients' excess weight loss increased steadily over time with a median of 32% at six months and 53% at twelve months. The median initial BMI of 44.5 kg/m2 and a median age of 50 years. There were 2 (10%) men and 18 (90%) women; 5 (25%) were Hispanic and 15 (75%) were non-Hispanic. The patients had a median 11.5 comorbidities. There were no deaths. Nausea was common for about seven days postoperatively.

Conclusion: Based on our experience, LSG with endoscopic guidance appears safe and effective; it might be tried on a larger set of patients as a single-stage operation.