Introduction: Chronic staple line disruption is not a frequent complication after sleeve gastrectomy (SG) but when its present it represents a high burden to the patients. The incidence is around ~2%.

Methods: We present the case of a 61 years old female with a prior SG performed outside of the US in 2019, intra-abdominal abscess, multiple laparotomies, and long ICU stay (5 months). After proper nutritional optimization, the patient was taken to the OR. The abdominal cavity was accessed in a standard fashion. Upon entry into the abdominal cavity massive amount of adhesions were visualize as excepted and with a combination of ultrasonic, blunt and sharp dissection were carefully taken down to gain access in the area of the left lobe of the liver. Significant chronic inflammatory changes were found in this area. The dense adhesions at this level were carefully dissected until the right crus of the diaphragm was visualized. Splenic vein bleeding is encountered and controlled with suture material. Proximal gastrectomy was performed and EJ reconstruction was attempted but, due to the poor understanding about small bowel anatomy and unexpected anastomosis no matching with the patient surgical history decision was made to convert to open where we found only 200cm of small bowel. The procedure was completed leaving 40cm of BP limb, 60cm alimentary limb and 100cm of common channel.

Results: Procedure was completed without complications.

Conclusions: Minor surgical procedures are effective in approximately 50% of patients. When the leak becomes chronic PGEJ can provide a long-term solution.