OBJECTIVES: The objective of this review was to assess the need for intraoperative surgical interventions to prevent bleeding and leaks during the two most common procedures for bariatric surgery, laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: A literature search was performed using MEDLINE^®, EMBASE^TM, and Biosis from January 2010 through November 2014. Titles were searched using key words laparoscopic sleeve gastrectomy, sleeve gastrectomy, or gastric bypass and filtered by searching the full citation for staple line, laparoscopic, leak or bleed, and intraoperative or intervention with appropriate truncations. Additional references extending to 2008 were cited by or referenced in manually filtered articles. RESULTS: The search yielded 144 titles and abstracts. From these, 11 full articles were reviewed and 6 were included, along with 11 additional articles identified through citations. For LSG, the incidence of intraoperative leaks and bleeds ranged from 1.15-3.93% and 1.08-4.07%, respectively. For LRYGB, leaks occurred in 3.79-8.26% and bleeds in 2.25-3.45% of cases. Lack of standardized leak testing methods makes inter-study comparisons difficult. Bleeds, considered a nuisance during surgery, are treated routinely with sealants or suturing but may be self-limiting and often go unreported. Intraoperative leaks and bleeds are associated with variables in stapler efficacy and influenced by inherent characteristics of the tissue as well as the experience of the surgeon. The use of staple line buttressing, oversewing, and/or tissue sealants appears to be common practice as a precautionary measure but has been criticized as unnecessary and having a negative impact on efficiency factors such as operative time, cost, or length of stay. CONCLUSIONS: Widespread use of precautionary measures and underreporting suggest the incidence of intraoperative leaks and bleeds at the staple line may be underestimated. Improvements in stapler design may increase efficiency while reducing the cost of precautionary measures and intraoperative interventions.