Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. 1. Introduction Morbid obesity has become a common epidemic in the western cultures and is slowly spreading to the rest of the world. By year 2025, it is estimated that 40% of American society will be morbidly obese [1]. Although many dietary therapies are available, patients seem to be most responsive to surgical intervention. Current surgical strategies consist of laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGBP), and laparoscopic biliopancreatic diversion with duodenal switch (LBPD-DS) [1]. LSG has become popular due to its simplicity and low complication rate. LSG was first performed in 2000, by Gagner and Patterson, as part of a duodenal switch procedure [2]. Regan et al. suggested sleeve gastrectomy as the first step in gastric bypass surgery as an alternative procedure in high-risk obese patients to decrease mortality and morbidity [3]. Currently, many surgeons are considering LSG as a stand-alone procedure that offers a substantial weight loss for the obese patient [4, 5]. It has been shown to be as effective as reducing excess weight by 60–70% within 3 years [5]. The physiological and anatomical reasoning supporting the efficacy of LSG is attributed to the reduction of total gastric capacity, illustrating a restrictive effect [4, 6–8]. In addition, an orexigenic/anorexigenic hormonal modification is evident due to the removal of fundal ghrelin-producing cells [4, 6]. LSG is a simple surgical procedure resulting in low complication rate with insignificant long-term nutritional deficiencies, especially when compared to the other alternative, more aggressive bariatric procedures. Its complications consist mainly of staple-line bleeding, strictures (usually located at the middle or distal portion of the residual stomach), and the most severe, dangerous complication being
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