Background: Leakage is a dreaded complication of bariatric surgery. The aim of this study was to describe 
the clinical presentation and outcomes of treatment in patients who develop gastrointestinal leaks after 
bariatric surgery.
Methods: Retrospective review of 632 consecutive bariatric surgical procedures performed from 1999-2009 
in Alexandria University Hospital, Egypt.
Results: leakage occurred in 10 patients. Symptoms and signs included tachycardia, fever, tachypnea, left 
shoulder pain, abdominal pain, chest pain, and/or change in the nature of the drain effluent. The average 
time to diagnosis was 3.9±2.6 days. Six leaks occurred after laparoscopic vertical banded gastroplasty (6.3%), 
2 after laparoscopic gastric bypass (3.6%), one after open gastric bypass (2.3%), and 1 after laparoscopic 
sleeve gastrectomy (2.4%). The most common leak location was at the esophagogastric junction (70%). Four 
patients (40%) required reoperations. A percutaneous abdominal drainage was placed in five patients (50%). 
In 2 patients (20%), the prophylactic drain was maintained in situ till cessation of leakage. Two patients 
(20%) died. Mean hospital length of stay was 13.9±7.8 days.
Conclusions: Leakage is a serious complication after bariatric surgery with a significant mortality. Patients 
with signs of sepsis or hemodynamic instability require emergent exploration. Leaks that are more insidious 
may be treated successfully with percutaneous drainage or maintenance of prophylactic drains.