[Management of staple line leak after sleeve gastrectomy using endoscopic suturing and stent placement]

Sleeve gastrectomy has been the most commonly performed metabolic surgical procedure in recent years. One of its rare but serious postoperative complications is staple line leak. Due to the high intraluminal pressure within the gastric sleeve, its management is technically challenging. Over time, treatment strategies have shifted from surgical approaches toward interventional radiologic and endoscopic techniques. In this case report, we present a 37-year-old female patient who underwent sleeve gastrectomy for morbid obesity. Postoperatively, she developed abdominal symptoms prompting a CT scan, which initially revealed a perigastric hematoma. This was drained by interventional radiology. Following drain removal and a brief period of clinical improvement, her symptoms recurred. A repeat CT scan demonstrated contrast extravasation and a collection adjacent to the staple line. A new percutaneous drain was inserted via interventional radiology. She was then referred to our bariatric unit, where the defect was definitively closed using endoscopic suturing system under general anesthesia, followed by placement of a self-expanding metal stent. The stent was well tolerated, with no migration. After 5 weeks, it was successfully removed. A subsequent CT scan showed no further contrast leak. The patient is currently asymptomatic, satisfied with her weight loss trajectory and quality of life. This case highlights that the management of staple line leaks after sleeve gastrectomy has evolved, with less invasive methods – such as interventional radiology and endoscopy – and their combination now playing a central role in treatment. Orv Hetil. 2025; 166(46): 1827–1832.