The Evolving Management of Leaks Following Sleeve Gastrectomy

Purpose of ReviewSleeve gastrectomy has become one of the most common bariatric surgical procedures world-wide. The complication rate overall is low, but staple line leak remains one of the most morbid and difficult to manage complications. The management of staple line leaks has evolved over time and now several non-operative, endoscopic, and surgical options exist with varying rates of success.Recent FindingsBased on the available data some interventions appear to be more efficacious than others, and modern management has moved towards a core set of practices. Endoscopic interventions may help many patients avoid operative intervention. Importantly, many patients may require repeated and varying interventions to fully resolve their leak.Each case should be managed by a multidisciplinary team with the interventions chosen based on patient factors, leak characteristics, and institutional capabilities. Nutritional optimization remains paramount to promote healing regardless of the interventions used.