Background

Postoperative leaks after bariatric surgery represent a serious complication, with an incidence ranging from 0.2% to 1.2%. They occur more frequently following laparoscopic sleeve gastrectomy due to the long staple line and increased intraluminal pressure. In recent years, endoscopic stent placement has become a well-established, minimally invasive, and effective therapeutic alternative, achieving success rates of up to 92%.

Case Report / Endoscopy

We present the case of a 56-year-old woman with morbid obesity who underwent laparoscopic sleeve gastrectomy. On postoperative day 5, she developed severe sepsis requiring hospital admission. Contrast-enhanced computed tomography revealed a proximal staple line leak associated with a perisleeve fluid collection. Urgent surgical exploration was performed but no active leak was identified.

Due to ongoing clinical deterioration, an upper gastrointestinal endoscopy with fluoroscopic guidance was performed, confirming a proximal dehiscence of the staple line with contrast extravasation into the subcardial recess of the gastric sleeve. Initial endoscopic closure attempts using the OverStitch suturing system and through-the-scope clips were unsuccessful. Consequently, a fully covered self-expandable metal stent (Hanarostent Gastro-Seal, 26 mm diameter × 21 cm length) was deployed, extending from the gastroesophageal junction to the pylorus, effectively excluding the leak site.

Endoscopic and radiologic follow-up demonstrated complete resolution of the leak. The stent was removed one month later without complications.

Conclusions

This case highlights the pivotal role of therapeutic endoscopy in the management of postoperative complications following bariatric surgery. Fully covered metal stents offer an effective, minimally invasive option for the treatment of sleeve gastrectomy leaks, often avoiding the need for reoperation and promoting faster, safer recovery.