Laparoscopic sleeve gastrectomy (LSG) has rapidly become the preferred procedure in bariatric surgery. Because of the increased intraluminal pressure and the presence of an intact pylorus, leaks after LSG have a tendency to perpetuate and become chronic. The management of leaks depends primarily on the clinical presentation of the patient, but a leak’s location and chronicity also play a significant role in management. In general, patients with hemodynamic instability need to be treated aggressively and expeditiously with surgical intervention, whereas more stable patients can undergo less-invasive interventions, such as percutaneous drainage and an endoscopic approach. However, once the leak becomes chronic, the role of endoscopic and percutaneous approaches is uncertain, and often more radical surgical intervention is required. Among the surgical options for chronic leaks, Roux-en-Y mucosa-to-mucosa anastomosis and proximal gastrectomy with Roux-en-Y reconstruction have delivered durable results, with acceptable complication rates.