Gastric Sleeve Complications and Risks
Are you considering Gastric Sleeve Surgery in Tijuana, Mexico and curious about the risks from this procedure comparing to its benefits?
Gastric Sleeve is an effective tool for patients to fight obesity through rapid weight loss while improving obesity-related diseases, like type II diabetes, hypertension, sleep apnea, joint problems, depression, etc. Sleeve procedure offers similar results but is a safer, less complicated in comparison to procedures like gastric bypass or duodenal switch that provide a malabsorptive component that alters patients’ anatomy.
Sleeve surgery complications are few and far between because of the “less-invasive” nature of restriction only procedures. The most common and life-threatening gastric sleeve surgery complications are leaks, staple line bleeding, and strictures.
Any surgery runs the risk of complications occurring both during and after the operation. By taking the time to understand them fully, you give yourself the opportunity to decide if the Gastric Sleeve complications and risks seem worth the chance of having the surgery.
It’s important to talk to your doctor and to understand all the complications and risks before undergoing any surgery.
Gastric Sleeve Gone Wrong
The potential difficulties associated with sleeve surgery can be realized as mild to severe and post-operatively to long-term as follows:
1. Immediate Post-Op Complications: Also known as acute complications, these occur shortly after the operation up until six months post-op. Immediate complications include pain, bleeding, and leakage.
2. Long-Term Complications: Also known as chronic issues, long-term complications may occur or carry on up to six months following surgery. These complications can be harder to detect and include GERD, stricture, or hair thinning.
3. Other Possible Complications and Risks: Other potential, but extremely rare complications and risks include perforation of the stomach or intestines, injury to the spleen, bowel obstruction, pneumonia (fluid in the chest), heart attack, congestive heart failure, irregular heartbeat, stroke, eating disorders, postoperative depression, urinary tract infection, allergic reaction to post-operative medications, gallbladder disease, ulcers, anemia, weight gain, and weakness.
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1. Immediate Post-Op Complications
The complication of post-op hemorrhage or bleeding has been reported to be between 1% and 6% after gastric sleeve (source). The source of bleeding can be Intraluminal bleeding from the staple line or extraluminal bleeding from gastric staple line, spleen, liver or abdominal wall at the sites of trocar entry.
Symptoms/Diagnosis: Physical findings, serial CBC (Complete Blood Count)
Management: Transfusion with or without laparoscopy/laparotomy
– Gastric Sleeve Leakage
A leak in the stomach or intestine can be proximal leak near the gastroesophageal junction or in the body of the sleeve. Gastric sleeve leaks are categorized into two terms describing their causes, mechanical-tissular or ischemic. A mechanical-tissular category can be caused by stapler misfiring, by improper closure of the suture area or direct tissular injury.
The leak usually appears within two days of surgery. Tissue ischemia in the gastric wall next to the staple line is the other category of the gastric leak. The leak appears as a classic ischemic fistula between 5 and six days after surgery.
Stomach leak needs to be monitored carefully after surgery and before a patient is discharged for recovery. Most leaks are diagnosed and treated immediately. Your surgeon will perform several leak tests in the hours and days that follow your surgery to ensure it is safe for you to return home. Up to 5% of patients following gastric sleeve can get staple line leak. Learn more about Gastric Sleeve Leaks.
Symptoms/Diagnosis: Physical findings, UGI (Upper Gastrointestinal) series
Management: Drainage (infrared laparoscopy), antibiotics with or without stenting and repair
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 problems, 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
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.
The Complication rate for gastric sleeve varies from 0% to 8% with a National Average of 2.8%. Mexico Bariatric Center gastric sleeve complication rate average is close to 0% (0.5%).
3. Other Possible Complications and Risks
To remove the large portion of the stomach, vessels that share common circulation between the greater curvature of the stomach and spleen need to be divided. If the surgeon is inexperienced and does damage to the spleen, a significant blood loss can occur, and complete removal of the spleen may be required to control the bleeding.
– Gallbladder Removal After Sleeve Surgery
Gallbladder removal, or Cholecystectomy, may be needed if gallstones form due to the rapid weight loss after sleeve surgery. There is a 50% risk of gallstones in patients undergoing gastric sleeve surgery. Although it is usually benign, gallstones can induce nausea, vomiting, and pain in the upper abdomen as well as upper back.
Approximately 23% of patients need gallbladder removal surgery after gastric sleeve. Some surgeons routinely remove gallbladder during gastric sleeve. Mexico Bariatric Center, however, does not remove gallbladder during the surgery unless it is needed (if the gallbladder is in perfect condition, we will not remove it even if it’s requested).
Sleeve Surgery Complications Symptoms
Early detection of post-op gastric sleeve complications is important, especially with bleeding, staple line leak, and development of an abscess. There are also delayed complications following sleeve, including strictures, nutritional deficiencies, and Gastro-Esophageal Reflux Disease (GERD).
How to Reduce Complication Rate
The potential complications of gastric sleeve surgery can be reduced if you follow the preparation and recovery plans given to you by your surgeon. By choosing one of our competent and qualified bariatric surgeons, Mexico Bariatric Center will provide you with the best possible outcome for your weight loss surgery decision. Ultimately, this allows your fears to dissolve.
It’s no secret that when choosing gastric sleeve that the benefits of undergoing any type of weight loss surgery procedure far outweigh the risks of not undergoing the surgery. Please contact our staff today to see if you’re a candidate for gastric sleeve surgery.
Guide to Gastric Sleeve Surgery: