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Background: Sleeve gastrectomy is the most commonly performed bariatric surgery, and complications from staple line leaks occur in 1 to 3 percent of patients. Endoscopic management can avoid additional surgery by successfully healing the leak; however, in some cases, surgical intervention is required. Definitive surgical management is mainly accomplished with esophagojejunostomy (EJ) or fistulojejunostomy (FJ). Proceeding with surgical management of these leaks is poorly understood, given the rare need and high risk. Methods: An institutionreviewed, board-approved, prospectively gathered database was used to identify patients undergoing definitive surgical management for bariatric surgery leaks with either an EJ or FJ. Initial data that led to the leak, intraoperative factors, and postoperative outcomes were collected. Results: A total of 22 patients have undergone an EJ or FJ for definitive surgical management of a sleeve gastrectomy leak at our institution. Twelve patients underwent EJ, and 10 patients underwent FJ. There were six patients (27%) who had subsequent leaks after definitive surgery. Surgeries performed more than 90 days following the initial leak had a lower risk of subsequent leak at the definitive surgical operation. All subsequent leaks were healed with endoscopic therapy, and no further surgery was indicated. No deaths occurred. Conclusion: Bariatric surgery leaks are difficult to manage. When endoscopic management fails, EJ and FJ are safe and feasible salvage options. Additional leaks following these salvage operations can occur in up to 27 percent of patients. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.