2. Long-Term Complications
– Intra-Abdominal Abscess
The intra-abdominal abscess is a collection of pus localized to one area of the abdominal space. It is a rare (0.7%) possible complication following sleeve gastrectomy. Typically staying in the hospital and taking antibiotics clears the abscess.
Symptoms/Diagnosis: CT (Computed Tomography) scan, ultrasound
Management: Drainage, antibiotics
A stricture is narrowing of the sleeve that could present acutely after surgery due to tissue edema or more commonly in a delayed fashion. The symptoms include food intolerance, dysphagia or nausea, and vomiting. Strictures usually occur in the middle (mid-gastric) or distal portion (gastroesophageal junction) of the residual stomach.
Symptomatic short segment stenosis after laparoscopic sleeve gastrectomy may be treated with endoscopic balloon dilatation. Long-segment stenosis, however, may require laparoscopic conversion to Roux-en-Y gastric bypass.
Symptoms/Diagnosis: Chronic Endoscopy, UGI series
Management: Endoscopy (dilatation), surgery (seroyotomy)
Gastroesophageal reflux disease (GERD) is common in bariatric surgery patients, especially gastric sleeve patients. Unlike Roux-en-Y gastric bypass, sleeve gastrectomy does not help GERD, and it may contribute to it. Chronic backflow of stomach contents into the esophagus can change the cells lining and can lead to scar tissue that makes it difficult to swallow to cancer.
Symptoms/Diagnosis: Chronic History, endoscopy
Management: Treatment with proton pump inhibitor
– Nutrient Deficiency
Nutritional deficiencies are common after bariatric surgery, including the gastric sleeve. The is due to impaired absorption and decreased oral intake. A recent study showed the prevalence of vitamin B12, vitamin D, folate, iron, and zinc deficiency. In general, the nutritional deficiencies are less prevalent after gastric sleeve than Roux-en-Y gastric bypass. A routine blood test is recommended by surgeons, after sleeve gastrectomy.
Symptoms/Diagnosis: Chronic Physical findings, blood work
Management: Nutritional supplements
Nausea is one of the most common side effects of gastric sleeve surgery. Nausea is frequently induced by eating too much after surgery. Because of the reduction in the stomach, it will be very easy to reach your stomach capacity with a minuscule amount of food.
This is especially true during the first few weeks immediately following your gastric sleeve surgery. When you overeat, you will feel nauseous. Please note that nausea can also be caused by not chewing your food enough or by drinking while eating.
It is important that you get into the habit of drinking between meals instead of during meals following your bariatric surgery. The key to avoiding nausea is to eat slowly, take smaller bites, chew your food thoroughly, and to stop eating after you begin to feel full.
– Hair Thinning
Hair thinning or “shedding” after bariatric surgery is very common, typically caused by the hormonal changes that occur when you start losing weight so quickly. Most of the time, it rarely lasts longer than six months following bariatric surgery.
The good news is that your hair will typically start growing again unless you have a chronic illness or genetic reason for hair thinning. Relax and don’t worry! It is natural to lose 5-15% of your hair during the first six months following the procedure; it grows back. Follow the suggested dietary plan and keep up with proper vitamins (bariatric specific vitamins) and protein.
Constipation may arise after gastric sleeve because of the dietary changes that come with gastric sleeve surgery. Another reason for constipation is that many individuals postoperatively will be drinking less water than before, causing dehydration.
Remedies for Constipation after Gastric Sleeve: If you still have minor constipation, physical activity will help alleviate constipation via bowel stimulation. Also, drinking the necessary sixty-four ounces of water per day.
– Blood Clots
Pulmonary Embolism (PE) usually occurs when a blood clot, called a Deep Vein Thrombosis (DVT) formed in your leg, travels to your lungs and blocks a blood vessel. That causes low oxygen levels in your blood and can damage the lung, other organs, and heart.
Birth Control Pills can cause the formation of blood cloth in the leg.
Blood clotting and pulmonary embolism is a rare but serious issue causing shortness of breath, elevated heart rate, heart attack, and even death.
You are at a higher risk for blood clot problems if you are obese, smoke, use oral contraceptives, are over 40 years old, experience trauma, are pregnant, have congestive heart failure, varicose veins, have previous blood clot issues, are a cancer patient or have a disorder that causes clotting.
To minimize your risks of a blood clot or pulmonary embolism after gastric sleeve surgery, we recommend walking every day after the surgery and performing calf muscle exercises. Compression stockings also help your veins and leg muscles move blood more efficiently. Elevating your legs especially during the night can be very effective.
– Dumping Syndrome
Dumping syndrome is a group of symptoms that develop most likely because of surgery that was done to remove a part or all of a stomach. It can also occur if the stomach has been bypassed to help a patient losing weight. Dumping syndrome is also called rapid gastric emptying. Dumping syndrome often happens when the undigested content of the stomach moves too fast through the bowel. Some dumping syndrome symptoms include nausea, diarrhea, and cramps.
Dumping syndrome can happen to bariatric surgery patients who eat too much when adjusting to their new stomach capacity. Most of the time the symptoms will occur from one to three hours after eating occurs. Some people may experience them at different times.
To dumping syndrome from occurring, the post-operative diet may need to be modified. In severe cases of dumping syndrome, a patient may need medication or even surgery.
– Stomach Stretching
The stomach can stretch after gastric sleeve surgery and stomach stretching is a common and expected occurrence. Pouch stretching is not a concern by bariatric surgeons since the increased capacity of food is hormonal and not the size of the stomach.
– Sleeve Stomach “Shape”
If gastric tube in sleeve surgery is not done by proper stapling and is not cylindrical-shaped, it can create high pressure at the proximal-most corner of the staple line. The staple line could be spiral-shaped or have jagged edges. The sleeve gastric tube can heal in “S” or “L” shape.
– Dilated Esophagus
The extra bite that we all want to have can cause esophageal dilations in patients after gastric sleeve. It can be only detected in barium swallow when barium sits there in the esophagus.