Background

Patient is a 33-year-old female with a history of morbid obesity, BMI : 5 kg/m² and gastroesophageal reflux disease. She presented to our clinic with typical reflux symptoms and was interested in weight loss surgery. Pre-operative esophagogastroduodenoscopy revealed a hiatal hernia of 2.5 cm in width and 3 cm of axial displacement and a non-obstructing Schatzki's ring. After discussion of surgical options patient elected to undergo laparoscopic sleeve gastrectomy with hiatal hernia repair.During the procedure the powered linear stapler used to create the sleeve gastrectomy had a critical stop at 50% at the time of firing. It was manually retracted back to starting point and manually opened. The stapler incision had to be enlarged. This video demonstrates the management of this complication with manual removal of the stapler and completion of the sleeve gastrectomy using a variable height linear stapler with staple line reinforcement. The patient had an uneventful recovery, was discharged home on postoperative day 2 and was last seen 4 months post-op doing well.