Gastric sleeve gastrectomy has become a frequent bariatric procedure. Its apparent simplicity hides a number of serious, sometimes fatal, complications. This is more important in the absence of an internationally adopted algorithm for the management of the leaks complicating this operation. The debates exist even regarding the definition of a leak, with several classification systems that can be used to predict the cause of the leak, and also to determine the treatment plan. Causes of leak are classified as mechanical, technical and ischemic causes. The management of leak post sleeve gastrectomy imposes a lot of controversies and difficulties in the adoption of a standard algorithm, https://www.laparoscopyhospital.com/a... Patients who fail initial conservative treatment, need a definitive surgical intervention with more aggressive and radical treatment, including either conversion to gastric bypass, or a Roux-En-Y with a jejunal limb oversewn over the fistula.