Long-Term Complications After Gastric Sleeve Surgery

Gastric sleeve surgery, also known as a sleeve gastrectomy, removes about 80% of the stomach to encourage weight loss. Aside from the risks inherent with any surgery, gastric sleeve surgery can result in a wide range of physical and mental health complications. Those related to weight and nutrition directly stem from the fact that the remaining, tube-like portion of the stomach can only hold about 4 ounces or 120 milliliters—a significant decrease from its normal capacity.

Risks vs. Rewards

The dramatic decrease in stomach size that results from gastric sleeve surgery means you can only eat about half a cup at a time (at least at first). Because the volume of food that can be eaten is restricted, the number calories that can be taken in is decreased. This is what leads to weight loss.

Gastric sleeve surgery is permanent and can lead to positive health outcomes for obese people who have struggled with achieving and maintaining weight loss. And overall, gastric sleeve is considered safe when compared to other commonly performed surgeries.

Deaths from the procedure are rare, and when performed by a competent surgeon, the surgery has minimal complications. That said, when they do happen, complications can range from minor annoyances to significant and potentially life-altering issues.

Acute complications are ones that occur shortly after surgery. They include bleeding, pain, antastamotic leaks (in the connections between the intestines), and blood clots. The chronic issues detailed here are long-term, meaning they arise or persist six months after the date of surgery.

Surgery is a tool, not a magic bullet. It still requires you to strictly follow discharge instructions, limit food intake, and follow the plan provided by your surgeon. It is possible to overeat and have minimal weight loss after surgery. It is also possible to have a serious complication either due to poor adherence to your post-surgical plan or the surgery itself.

Gastric Sleeve vs. Bypass vs. Banding

There are various forms of bariatric surgery, of which gastric sleeve is just one. There are several differences between them, and you should discuss all of these options with your doctor before settling on a procedure so that you can ensure that what you choose is the best option for you.

Here are just two key long-term considerations to keep in mind:

  • A gastric sleeve is permanent. Unlike the gastric band procedure—where the band that "cinches" the stomach to divide it into two pouches can be removed if there is a problem—the portion of the stomach removed with the sleeve procedure cannot be replaced if there are complications or issues with digestion.  
  • You may not lose as much weight with a gastric sleeve. While those who have gastric bypass surgery typically lose more weight and keep off a higher percentage of excess weight long term as compared to those who have gastric sleeve surgery, bypass can present with it's own set of challenging long-term issues.

Weight and Nutrition

While the purpose of gastric sleeve surgery is to promote weight loss, there is a chance that you may not lose as much as anticipated or that you lose weight, but gain it back again. Furthermore, while the reduction in food intake helps you reduce calories, that also means that you are consuming fewer nutrients—which could lead to deficiencies.

Failure to Lose

This is a serious problem where the surgery is ineffective for weight loss. The pouch may be too large, the patient may ignore discharge instructions, or another issue may be present that prevents weight loss.

Regain

In the initial days after the surgery, the stomach pouch that remains is very small and will hold about half a cup of food at one time. Over time, the pouch stretches and is able to accommodate larger amounts of food in one sitting. This dilation allows larger meals to be consumed and can eventually lead to weight loss stopping or weight gain starting. 

Losing weight after surgery only to gain some or all of it back typically starts in the third year after surgery, if it occurs at all. Bariatric procedures are a great tool for weight loss, but if habits are not changed and maintained, it is possible to gain some or all of the excess weight back again.

Nutritional Shortfalls

Unlike many gastric bypass surgeries, patients who have a gastric sleeve procedure do not have any change in their ability to absorb nutrients in the intestine. However, the dramatic decrease in food intake can lead to difficulties in taking in adequate nutrition. Issues like diarrhea and nausea might also cause problems with absorbing enough calories and nutrients as well.

In these cases, even an ideal whole-foods diet may not be adequate to supply all of the needs of the body. Because malnutrition can be very serious, your doctor may suggest using vitamin and mineral supplements, medication, and other interventions to keep you well long term. 

Food Intolerance

One of the benefits of a gastric sleeve is that all foods can be eaten after the procedure; other bariatric surgeries require that you avoid specific foods. However, that does not mean the body will tolerate all types of foods.

A 2018 study found that food tolerance decreased after vertical sleeve gastrectomy, particularly when it comes to foods like red meat, rice, pasta, and bread. The researchers noted that this is likely due to the anatomical and physiological alterations in restricting the amount of food you can eat at one time.

Physical Symptoms

Some patients may experience gastrointestinal issues as a complication of gastric sleeve surgery. While these may appear immediately following surgery, some patients may experience them for an extended period of time. Sagging skin may be another complication that you experience after surgery.

Dyspepsia

Indigestion, or an upset stomach, can be more frequent after gastric sleeve surgery. This may be due to the reduced volume of the stomach and changes in the way that food moves through your stomach and intestines.

Nausea

Nausea is one of the more common issues that patients face after sleeve gastrectomy. For most, this improves after recovering from surgery, but for others, the problem persists for months or even long term.

While it's not clear what causes nausea in this case, it may be partly due to food staying in your stomach for longer periods of time. Nausea medications are available, which may be helpful for some.

Diarrhea

For some patients, diarrhea is a serious problem that may persist after gastric sleeve surgery. This can occur for a number of reasons, including alterations in gut microbiota and rapid exposure of the small bowel to undigested nutrients.

In cases that last for an extended period of time, the surgeon or a gastroenterologist may be able to help stop diarrhea, which can lead to dehydration and malnutrition.

Sagging Skin

This complication is common with all types of weight loss surgeries and is the result of skin stretching during the period of obesity. A panniculectomy may be an option to remove excess skin, but many surgeons prefer to wait until the patient’s weight has been stable for one to two years prior to removing excess skin. 

Medical Issues

Gastric sleeve surgery can lead to medical conditions ranging from mild to severe. Talk with your doctor if you have any concerns about your likelihood of developing a medical issue after surgery.

Persistence of Chronic Conditions

For some, getting rid of chronic health problems—diabetes, hypertension, and others—is the reason for having this surgery. In some cases, these problems do not go away after surgery, or they may go away temporarily in the early months or years after surgery and return later.

Gastroesophageal Reflux Disease (GERD) 

Heartburn, along with other symptoms of GERD (bloating, feelings of fullness, and upset stomach), is common after this surgery and often requires medication.

Stomach Ulcers

Stomach ulcers, known as peptic ulcers, are more common after gastric sleeve surgery and are typically diagnosed during an upper endoscopy after the patient experiences bleeding (seen as a dark, tarry stool or as blood in vomit) or pain in the stomach area.

Gallstones

Gallstones are more common after all types of bariatric surgery, making a cholecystectomy (surgery to remove the gallbladder) more common for weight loss surgery patients.

Stomach Obstruction

Scarring and narrowing of the outlet of the stomach, also known as stenosis, can make it difficult or even impossible to digest food. This complication is typically fixed by a surgeon who “stretches” or surgically fixes the area that has become narrowed.

Abdominal Adhesions

The organs and tissues of the abdomen are naturally slippery, allowing them to slide past each other during movements such as bending, twisting, and walking. After surgery, scarring can make these tissues “stick” to each other. This causes a pulling sensation that can range from annoying to painful with movement. Abdominal adhesions can also lead to small bowel obstructions.

Abscess

An abscess is a collection of infectious material (pus) that forms in the body in a pocket-like area. This usually occurs shortly after the initial surgery, due to spillage or leakage of intestinal contents. In the case of gastric sleeve surgery, abscesses have been diagnosed in the spleen, some requiring the organ to be removed, but this is very rare. 

Delayed Leak

Most suture line leaks, also known as suture line disruption or SLD, are discovered shortly after surgery. In some cases, however, the area of the stomach that was sewn together will begin to leak months or even years after surgery.

These later leaks are much rarer but can be equally troublesome, and they may require medications, hospitalization, or surgery to correct. 

Incisional Hernia

A hernia can form at the site of any surgical incision. This risk is minimized by minimally invasive (laparoscopic) surgical techniques, but a hernia can still form in the months and years following such a procedure. Typically, this looks like a small bulge at the site of a surgical incision. 

Psychological or Social Concerns

Gastric sleeve surgery can affect your mental and emotional well-being, as well as your relationships with others. While weighing potential physical complications of the procedure is important, these shouldn't be overlooked.

Addiction Transfer

This is a phenomenon that happens to some individuals when they are no longer able to use food as a way to self-medicate their emotions. For example, after a hard day at work, it is no longer possible to go home and binge on an entire container of ice cream—it just won’t fit in the stomach.

Other types of addictions then become more appealing as they are still possible with the smaller stomach size—alcohol abuse, drug abuse, and sex addiction being among the most common after surgery.

Divorce

In the United States, an average of 50% of marriages end in divorce; some sources indicate that the rate of divorce after bariatric surgeries is as high as 80%. 

A 2018 study suggested that divorce rates after gastric sleeve surgery may increase because the dramatic weight loss that results can affect the dynamics of a relationship. This might happen if a partner feels jealous or no longer needed.

Patients who are considering the surgery are advised to talk with their partners about any potential issues and how they might handle tensions if they arise. Couples may benefit having this conversation with the help of a therapist.

A Word From Verywell

One of the important standards that research scientists look at when evaluating the success and safety of surgeries is 10-year outcomes. In this case, that pertains to how patients maintain weight loss, what their overall health looks like, and any complications they may have had due to surgery.

It is important to realize that gastric sleeve surgery is a relatively new procedure, so there is less 10-year data for gastric sleeve surgery than there is with other surgeries. As such, more long-term complications could be added to this list in the future.

You should go into any surgery confidently. Speak with your doctor about the known potential risks and complications of gastric sleeve surgery in your case, as well as any surgical alternatives that are worth considering, so you can make the most-informed choice for yourself.

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