Can a Gastric Sleeve Stomach Leak?

It is a worry many people have before a sleeve, and an honest answer helps more than a reassuring one. Yes, a gastric sleeve can leak. It is one of the most serious complications of the surgery, and it is uncommon. Here is what a leak is, how often it happens, what to watch for and what happens if one is suspected.

What is a leak?

During a sleeve, the surgeon divides the stomach with a stapler that places rows of small titanium staples, and removes the outer part. A leak happens when the staple line does not heal fully and a small opening forms. Stomach fluid then escapes into the belly, which can cause an infection that needs treatment quickly.

How often does it happen?

• In a U.S. quality registry of more than 93,000 sleeves done in 2015, leaks were recorded after 0.8%, fewer than 1 in 100.
• A study of more than 189,000 sleeves in the same registry found staple-line leaks after about 1 in 400.
• An earlier review of nearly 9,000 sleeves, from the first years of the operation, found leaks after about 2 in 100.

Leaks are more common after a revision operation than after a first sleeve, and some health factors, such as a very high BMI, can raise the risk. Your surgeon talks with you about your own risk at your consultation.

When can a leak happen?

Most leaks show up within the first few weeks after surgery, while the staple line heals, and often after you are already home. Less often, a leak appears later. Following the fluid and food stages closely gives the sleeve time to heal before it has to handle solid food.

Can a sleeve rip open?

This is a common fear. It is very unlikely that a healed sleeve splits open from eating. If you eat too much, you are more likely to feel pain, pressure or nausea, or to vomit. These are signals to stop, and to tell your team if they keep happening. A leak, when it happens, is usually a small opening during healing, not a sudden tear.

Signs to watch for

Call right away if you notice any of these in the weeks after surgery:

• A fast heartbeat at rest. This is often the earliest sign.
• A fever of 38 °C (100.4 °F) or higher, or chills.
• New or worsening belly pain, or pain in the left shoulder.
• Feeling short of breath, or breathing fast.
• Feeling very unwell, or vomiting that will not stop.
• Redness or fluid coming from an incision.

If a leak is suspected

Your heart rate, temperature and blood tests are checked, and you usually have a CT scan. Treatment depends on the size of the leak and how you are doing.

• Antibiotics.
• Resting the stomach, with nutrition given another way for a while.
• Draining the fluid with a thin tube placed through the skin.
• An endoscopic procedure from the inside, such as a stent or an internal drain.
• Sometimes, another operation.

Most leaks heal with treatment, although healing can take several weeks to a few months.

What your surgical team does

• Two bariatric surgeons perform every sleeve together.
• The staple line is reinforced with buttressing material, and the stapler adjusts to the thickness of the stomach wall.
• The surgeons check the staple line before the operation ends.
• A recovery nurse watches your heart rate, temperature and comfort in the first hours.
• You go home with clear instructions, a number to call and follow-⁠ups with your team.

These steps are meant to lower the risk, but no technique removes it completely. Research has not shown that any single step, including staple-line reinforcement, prevents leaks on its own. That is why knowing the signs and calling early matter.