Laparoscopic Sleeve gastrectomy was offerred to this patient for management of her obesity ( BMI 46). Patient was from Dhulia (Maharastra) and had specifically visited Surat for treatment. She is hypertensive and has hypothyroidism. She had history of previous 4 abdominal surgeries which was a challenge to us considering the adhesions open surgery creates. Patient also had large gall stone (22mm) and wanted removal in the same sitting. Attached are the specimen of remnant stomach and the gall bladder. She was discharged on the 2nd day after surgery.