The management of staple line disruption following sleeve gastrectomy is a controversial area. We propose a novel method of converting a leaking sleeve gastrectomy to a Roux-en-Y gastric bypass in the acute setting, regardless of whether the defect is able to be visualized. Our proposed method of undertaking a major surgical reconstructive procedure is seemingly counter to traditional surgical dogma, requiring two anastomoses within a potentially septic field. We present three cases of sleeve leak where the conversion to a gastric bypass acutely was completed successfully. Additionally the potential length of stay and number of procedures is decreased in a Roux-en-Y conversion compared to endoscopic therapeutic measures in the same setting.