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A middle aged women with history of old inferior wall myocardial infarction and BMI 42 underwent LSG. She had an eventless intraoperative period and was used five fires of green and blue staplers to cover the length of the sleeve. After, checking for any leak using the air leak test was done. At that time a moderate alarm was sounded by the peri-operative physicians that the nasogastric (NG) tube was struck somewhere as it was not coming out. Immediately by focusing on the remnant gastric sleeve a dimple was noticed around the mid of the sleeve every time the anaesthetist was trying to pull the tube out. The extracted gastric greater specimen was examined by opening the greater curve to find the severed distal end of the NG tube firmly stapled (Figure 1). Knowing that the NG tube has been stapled to the sleeve (Figure 2), the 36 Fr gastric calibration tube was reinserted into the sleeve, the staples of the attached area of the NG tube to the sleeve were cut and opened using an ultrasonic scissors creating a rent of around 1 cm which released the proximal NG tube and could be retrogradely

Misadventure during laparoscopic sleeve gastrectomy: why it happened? how to prevent and recover from it?