Endoscopic strategies for the treatment of postbariatric surgery leaks and fistulas

Obesity is fast becoming a worldwide epidemic. Bariatric surgery has gained acceptance as an outstanding procedure that provides clinically significant weight loss and metabolic outcomes. Despite improvement in technique and expertise, complications ensue. As the number of postbariatric surgery patients increase, it is crucial that one is able to identify and manage complications. In order to optimally manage these patients, one must be able to understand the postsurgical anatomy and physiology of the stomach. Herein, we discuss the most common sites of leaks after Roux-en-Y gastric bypass and sleeve gastrectomy. We propose a new and unique algorithm for management of sleeve gastrectomy leaks taking into consideration other factors that we feel contribute to successful healing and resolution.