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Safety guide · Sleeve gastrectomy
A gastric sleeve leak is uncommon, but it is one of the most serious complications of sleeve surgery and needs fast treatment. This guide covers what a leak is, how often it happens, the symptoms to watch for, who is at higher risk and how leaks are diagnosed and treated.
Before you leave the hospital, you have three leak tests and the medical team clears you for discharge.
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The basics
During a gastric sleeve, your surgeon removes about 75% to 80% of the stomach and staples the rest into a narrow tube. A leak happens when digestive juices and partly digested food escape through the staple line into the abdomen. Leaks can also happen after gastric bypass and duodenal switch.
Appears 1 to 3 days after surgery.
Appears 4 to 7 days after surgery.
Appears 8 days or more after surgery.
Most often near the top of the sleeve, where it meets the esophagus. In one study of 402 sleeve patients, all 26 leaks were in this area (Verras et al.).
A leak can be clinical, with symptoms, or subclinical, found only on tests. Knowing the type helps your surgeon choose the right treatment.
How common are leaks?
Leaks are rare after a first-time sleeve, and the rate has fallen as techniques improved. Revision surgery carries more risk.
Who is at risk?
Some leaks come from technical problems during surgery. Others are linked to your health. In the 692,554-patient study, leaks were more likely with these factors (Osti et al.).
Stop nicotine in all forms when your instructions tell you to, and stay off it.
Tell your surgeon about heartburn or reflux before surgery.
Keep taking your blood pressure medication unless your doctor says otherwise.
A sign of poor nutrition. Following your pre-op diet helps.
Such as steroids. List every medication on your health application.
A longer operating time raised the odds of a leak. Revision surgery also raises the risk, because the surgeon works on tissue that has already been operated on (Cornejo et al.).
Other reviews also list male sex, a BMI over 50 and sleep apnea as risk factors (Verras et al.).
When to get help
Symptoms vary and can look like other problems. Fever was the most common sign, found in 96% of leak patients in one study (Verras et al.). If you notice any of these, go to the nearest emergency room. Then let the Renew care team know.
Especially in the first weeks after surgery.
A heart rate over 120 beats a minute, or a racing heart that won’t settle.
Pain that keeps getting worse instead of better.
Sometimes with trouble breathing or fast breathing.
Or a general feeling of being very unwell or anxious.
Or fluid leaking from an incision.
Diagnosis and treatment
Your doctor will ask about your symptoms and examine you. Imaging tests use a contrast liquid that you drink so the sleeve shows up clearly. If tests are clear but symptoms continue, surgery may be needed to look for a leak.
| What it involves | |
|---|---|
| CT scan with contrast | The most sensitive test for a leak (Verras et al.) |
| Upper GI series | X-rays taken while you swallow contrast liquid |
| Antibiotics and drainage | IV antibiotics, and draining any infected fluid through a small tube |
| Endoscopic treatment | A stent or clips placed through the mouth to cover or close the leak |
| Nutrition support | Nothing by mouth while the leak heals, with feeding through a tube or an IV |
| Surgery | To repair the leak or reroute the stomach. Emergency surgery is needed if a patient is very unstable |
Treatment options from Verras et al.. Your doctor will explain the benefits, risks and side effects of each treatment.
Before and after surgery
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List every condition, medication and nicotine use on your health application.
Follow your pre-op diet and instructions. See the pre-op checklist.
Small sips and the staged post-op diet give your staple line time to heal.
Before discharge, you have three leak tests and the medical team clears you. After you go home, your coordinator and an on-call bilingual doctor are available for questions.
Send it to us and our surgeons will review your risks before recommending a procedure. Virtual consultations are available.
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“I am a nurse of 16 years so my expectations of care are very high. The nurses and Dr Perez exceeded all my expectations. I always felt safe and very well taken care of by them. Two weeks post op and no problems what so ever.”
“I had gastric sleeve on 6/12 with Dr.Green and he’s amazing! I woke up in recovery hurting but they kept it manageable and nurses stay in contact with checking vitals and encouraging your fluids.”
“I had VSG with Dr Perez 1/12/24 in Tijuana. Surgery went very well and I had wonderful care. Recovery has been pretty easy. The key is walking!”
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Rare. In US and Canadian data on 692,554 first-time sleeve patients from 2016 to 2021, 0.17% had a leak within 30 days.
Most appear in the first days or weeks after surgery. Early leaks show up 1 to 3 days after surgery, intermediate leaks at 4 to 7 days and late leaks at 8 days or more.
Fever, a fast heart rate, worsening belly pain, shoulder or chest pain, trouble breathing, nausea or vomiting. If you notice any of these, go to the nearest emergency room. Then let the Renew care team know.
Leaks are more likely with smoking, reflux, high blood pressure, low albumin, immune-suppressing medication, longer operations and revision surgery.
Treatment can include IV antibiotics, drainage, an endoscopic stent or clips, nutrition through a feeding tube or IV, and sometimes surgery.
Yes. Your package includes three leak tests, and the medical team clears you before discharge.
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Free, no-obligation review
Form loading. Prefer to talk? Call (844) 736-3963, available 24/7.
No commitment. A coordinator will contact you.
