Refractory gastric leak following salvage surgery after gastrectomy: a systematic review, case report, and management algorithm
In brief
Endoscopic treatment succeeded in 91% of reported refractory gastric leaks
A review of 10 studies and one new case included 47 patients: overall clinical success was 87.2%, and endoscopic treatment succeeded in 90.6%; repeat surgery alone succeeded in 62.5% and was associated with higher mortality. These small, nonrandomized reports favor a stepwise approach that starts with endoscopy when there is no acute peritonitis, but cannot establish which strategy is best.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 14 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Botao Qian, Liangjun Mao, Kun Wei, Shihua Ma, Qianyu Liu, Yingcai Zhou, et al.
- PMID
- 42995062
- DOI
- 10.1016/j.soard.2026.10.005
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 7 November 2026): Systematic review of severe sleeve-related leak management
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.