Long-Term Complications After Gastric Sleeve Surgery

The gastric sleeve procedure, also known as a sleeve gastrectomy, is a surgery that decreases the size of the stomach to encourage weight loss. About 80 percent of the stomach is surgically removed, leaving a tube-like portion of the stomach in place, and removing the rest permanently. The remaining stomach can initially hold about 4 ounces or 120 milliliters, a significant decrease from the normal size of the stomach.

This dramatic decrease in stomach size means the individual can only eat about half a cup at a time and restricts the volume of food that can be eaten, which in turn decreases the calories that can be taken in, leading to weight loss.

Despite the decrease in stomach size, surgery is a tool and still requires the individual to follow discharge instructions, limit food intake, and follow the plan provided by the surgeon. It is possible to overeat and have minimal weight loss after surgery. It is also possible to have a serious complication after surgery, so the procedure must be taken seriously, like any surgery.

There are two types of complications of gastric sleeve surgery: acute and chronic. Acute complications are ones that occur shortly after surgery and chronic issues are ones that arise or persist six months after the date of surgery. Acute complications include bleeding, pain, and blood clots.

Gastric sleeve, overall, is considered safe when compared to other commonly performed surgeries. Deaths from the procedure are rare, and when performed by a competent surgeon, the procedure has minimal complications. That said, complications, when they do happen, can range from minor annoyances to significant and potentially life-altering issues.

It is also important to realize that this is a relatively new surgery. One of the important standards that research scientists look at is 10-year outcomes. In this case, that information is about how patients are maintaining their weight loss, what their overall health looks like, and any complications they may have had due to surgery.

Long-term complications:

• Initial 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.
• Intolerance of foods: One of the benefits of this procedure is that all foods can be eaten after the procedure, while other bariatric surgeries require that you avoid specific foods. That does not mean the body will tolerate all types of foods, it just means that no foods are forbidden after the procedure.
• Sleeve dilation: 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 allows larger meals to be consumed and can eventually lead to weight loss stopping or weight gain starting.
• Dyspepsia: Indigestion, or an upset stomach, can be more frequent after the gastric sleeve surgery.
• 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: While not a physical problem after surgery, divorce is certainly a potential complication that should be considered. In the United States, an average of 50 percent of marriages ends in divorce, while some sources indicate that the rate of divorce after bariatric surgeries is as high as 80 percent. 
• Gastroesophageal reflux disease (GERD): Heartburn, along with other symptoms of gastroesophageal reflux disease that include bloating, nausea, feelings of fullness, upset stomach, is common after this surgery and often requires medication. 
• Stomach obstruction: Scarring and narrowing of the outlet of the stomach, also known as stenosis, can make it difficult or impossible to digest food. This complication is typically fixed by a surgeon who “stretches” or surgically fixes the area that has become narrowed.
• Abscess: An abscess is a collection of infectious material (pus) that forms in the body in a pocket-like area. In this case of gastric sleeve surgery, abscesses have been diagnosed in the spleen, some requiring the spleen to be removed, but these are very rare. 
• Delayed leak: Most suture line leaks, also known as suture line disruption or SLD, are discovered shortly after surgery. In some cases, 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 than those diagnosed shortly after surgery but can be equally troublesome and may require medications, hospitalization, or surgery to correct. 
• Stomach ulcers: Stomach ulcers, known as peptic ulcers or peptic ulcer disease (PUD), 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. 
• Nausea: Nausea is one of the more common issues that patients face after sleeve gastrectomy. For most, the issues improve after recovering from surgery, but for others, the problem persists for months or even long term. Medications are available for nausea, which may be helpful for some.
• 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. Caucasian females over the age of 40 who are overweight, with or without surgery, are more likely to need gallbladder surgery during their lifetime with or without bariatric surgery. 
• Diarrhea: For some patients, diarrhea is a serious problem that may persist after surgery. 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.
• Need for nutritional supplements: Many bariatric surgery patients require supplements of vitamins and minerals after surgery. 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, but the dramatic decrease in food intake can lead to difficulties taking in adequate nutrition. This can be helped by eating a whole foods diet, but even an ideal diet may not be adequate to supply all of the needs of the body.
• Regain: One of the complications that gastric sleeve patients worry about the most is losing weight only to unintentionally gain weight back. Losing weight after surgery only to gain some or all of it back typically starts in the third year after surgery. 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.
• Permanency: The surgery, for better or for worse, is a permanent alteration of the stomach. Unlike the gastric band procedure, where the band can be removed if there is a problem, the portion of the stomach cannot be replaced if there are complications or issues with digestion. 
• Less weight loss than other procedures: Individuals who have gastric bypass surgery typically lose more weight and keep off a higher percentage of excess weight long term when compared to gastric sleeve surgery. That said, those surgeries can present with different and challenging long-term issues. The choice of surgery is a very personal decision best made by the patient and their surgeon, based on their individual needs.
• Diabetes, hypertension, and other chronic conditions do not resolve: For some, getting rid of chronic health problems is the reason for having the surgery. In some individuals, these problems do not go away after surgery, or they may go away temporarily in the early months or years after surgery, then return later. 
• 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. Surgery is available 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. 
• Malnutrition: This issue comes in a variety of forms. There can be a decreased intake of minerals and vitamins that leads to a lack of essential nutrients. There can be an inability to take in adequate calories. There can be a problem with absorbing enough calories and nutrients, due to issues such as diarrhea, nausea, or other issues. Malnutrition can be very serious and may take supplements, medication, and other interventions to keep the patient well long term. 
• 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 surgery. Typically, this looks like a small bulge at the site of a surgical incision. 
• Abdominal adhesions: The organs and tissues of the abdomen are naturally slippery, allowing them to move and slide past each other during movements such as bending, twisting, and walking. After a surgery, scarring can make these tissues “stick” to each other, and this causes a pulling sensation that can range from annoying to painful with movement.