Natural orifice translumenal endoscopic surgery (NOTES) has become an exciting area of surgical development. However, significant limitations to this surgical concept include the lack of surgical expertise and appropriate flexible instrumentation. An alternative and competing technology to NOTES is Natural Orifice Transumbilical Surgery (NOTUS).

We describe a 53 year old female in whom a laparoscopic sleeve gastrectomy was performed with all surgical incisions placed within the umbilicus. The greater curve of the stomach was mobilized to the angle of HIS. A 32 Fbougie was placed and a vertical sleeve gastrectomy was performed. A staple misfire was noted with disruption of the staple-line. We converted from a single incision to 5 abdominal trocars technique. The staple-line disruption was repaired by stapling of the stomach medial to the disrupted staple-line.

The operative time was 120 minutes with an estimated blood loss of 25 mL. Her hospital course was unremarkable. The patient was started on a liquid diet on day two and was discharged home on postoperative day three.

Staple-line failure is a potential complication during sleeve gastrectomy. Recognition of disrupted staple-lines and appropriate management are keys in avoiding staple-line leaks.