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Introduction Bariatric surgery, specifically laparoscopic sleeve gastrectomy (LSG), has become one of the standard bariatric operations in the U.S. for weight loss and improvement in associated co-morbidities. It has been shown that associated co-morbidities such as obstructive sleep apnea, diabetes mellitus, hypertension, hypercholesterolemia, and obesity have all been improved, if not cured. Many bariatric surgeons insist on over-sewing the staple line in an attempt to minimize post-operative leaks and/or hemorrhage, without substantial evidence to support the benefit of applying this additional step. Methods Retrospective data for the first 50 consecutive patients undergoing LGS and conversion from laparoscopic gastric banding (LGB) to LSG from September 2014 to April 2015 at Larkin Community Hospital were analyzed. All patients were seen and evaluated pre-operatively in the private practice of the bariatric surgeon. Each case was completed with two surgeons and one resident. The majority of the case was split between one of the two surgeons in the Bariatric practice and the resident assisting. The LSG was performed without over-sewing the staple line and none of the patients received an upper GI series or any pharmaceutical anticoagulation while they were hospitalized. All patients were discharged on POD# 1. Results Weight loss at 1 and 3 months were 19.6 lbs (8.91 kgs) and 41.3 lbs (18.8 kgs) respectively. The most common complication was hair loss in the post-operative period (3/50). No major complications including, but not limited to, leaks, fistulas, pulmonary emboli, or deep venous thrombosis were observed. Conclusion Our technique, to our knowledge, is the first to describe laparoscopic sleeve gastrectomy without over-sewing the staple line, no post-operative anticoagulation, no UGI series on POD#1, and discharge home on POD#1 with no major complications. Highlights