Background: Laparoscopic sleeve gastrectomy (LSG) is one of the common bariatric procedures for the treatment of morbid obesity. One of the most serious complications of this procedure is leak. Objective: This study compared sleeve gastrectomy (SG) staple-line leak rates of 2 prevalent surgical options: no reinforcement, and over sewing, no absorbable suture. Materials and Methods: Analysis of the influence of technical adaptations on the outcome of LSG was performed in a nested case-control group of patients. The main modification adapted was performing invagination sutures over the staple line. The primary outcome was the occurrence of leak. The secondary outcomes were bleeding, operative time, prolonged hospital stay, and mortality. Results: We included selected group of patients who underwent sleeve gastrectomy (SG) for treatment of morbid obesity between May 2014 and May 2016. The performance of intra operative leak testing (IOLT) by (methylene blue). The group who had invagination sutures (group 2) had a significantly lower frequency of leak (0%) than those without invagination sutures (7.3%; group 1). There was no significant difference in the occurrence of postoperative bleeding, hospital stay or mortality between the groups. Conclusions: The procedure’s safety overall is good; developing proven surgical strategies to minimize the risk of potentially life-threatening staple-line leak after LSG is of critical importance. Invagination sutures of the staple line have received great attention as prophylactic measures against leaks, and effective in reducing the incidence of leak.