Refractory gastric leak following salvage surgery after gastrectomy: a systematic review, case report, and management algorithm

Refractory gastric leak following salvage surgery after gastrectomy is a rare but severe complication with limited evidence to guide optimal management. We report a case of refractory gastric leak after sleeve gastrectomy with fundoplication and conducted a systematic review to evaluate treatment strategies and clinical outcomes. A comprehensive search of PubMed, MEDLINE, and Embase identified 219 records, of which 10 studies involving 46 patients met inclusion criteria; together with the present case, 47 patients were analyzed. The overall clinical success rate was 87.2%, with a mortality rate of 12.8%. Endoscopic management achieved a high success rate (90.6%), whereas combined surgical and endoscopic approaches resulted in complete resolution in all reported cases. In contrast, repeat surgical intervention alone was associated with lower success (62.5%) and higher mortality. These findings support a stepwise, individualized management strategy prioritizing minimally invasive endoscopic therapy in the absence of acute peritonitis. The proposed algorithm provides a practical framework for decision-making and may improve outcomes in this challenging clinical scenario.