A leak from the SG portion of the procedure has historically been the most common area for a leak after a duodenal switch. The incidence has been reported as 1 to 4 percent, depending on the study evaluated. Over the last 5 to 10 years, the incidence has dropped as surgeon experience has increased in performing the SG as a stand-alone procedure. The most common area for a leak is in the upper one-third of the sleeve due to narrowing or stricture of the sleeve at the incisura angularis (Figure 2). This will cause an increase in pressure in the sleeve with a blowout at the upper portion of the staple line near the gastroesophageal junction since this is the weakest point in the sleeve. The treatment of a sleeve leak in the acute setting without a significant obstruction involves a washout of the affected area with resuturing or restapling of the sleeve. Many of these can heal completely if addressed early enough with minimal contamination. In the chronic setting or with a chronic fistula, it gets a bit more complicated. Nutritional support and antibiotics are required initially, combined with adequate drainage. Drains can usually be placed via a surgical approach or with the aid of interventional radiology, but recent studies have shown that drainage can also be facilitated with endoscopic techniques, such as an endoscopic wound vac or endoscopic septotomy. The most important aspect though for definitive treatment is to look for and relieve the obstructive point, which is usually at the angularis. This can be done with placement of an endoscopic stent, but in reticent cases, eventual surgical resection and Roux-en-Y reconstruction might be required.