Gastric Sleeve Surgery Complications and Risks

Gastric sleeve surgery, also known as a sleeve gastrectomy, is a weight loss surgery that involves removal of about 80% of the stomach. Being such a significant operation, gastric sleeve surgery can result in a wide range of physical and mental complications soon or even long after the procedure.

Many gastric sleeve complications stem from the fact that, post-surgery, the stomach can only hold about 4 ounces (120 milliliters) of food. This is much less than normal.

It's important to be aware of possible gastric sleeve complications if you've had the procedure done, but also if you're still considering it. Learn about some of the potential short-term risks and long-term complications of gastric sleeve surgery in this article.

Gastric Sleeve Surgery Benefits and Risks

After gastric sleeve surgery, you will only be able to eat about half a cup of food at a time. When you eat less food than before, you take in fewer calories. This is how you lose weight.

Gastric sleeve surgery is permanent. It can improve the health of obese people who have had trouble losing weight and keeping it off.

Many patients hope this surgery will correct chronic health problems like diabetes and high blood pressure. Sometimes these problems do not go away after surgery.

Gastric sleeve and other weight loss surgeries are as safe as different kinds of surgeries. Deaths from the surgery are rare. The risk of death from a weight loss surgery is about 0.1%.

Acute risks are those that occur shortly after surgery and can include:

• Bleeding
• Pain
• Blood clots
• Anastomotic leaks (leaks that happen in the connections made during the surgery)

Gastrointestinal (GI) complications can lead to symptoms that affect your weight or nutritional status. These include:

• Failure to lose weight: The stomach pouch can only hold half a cup of food in the first days after surgery. Over time, the pouch stretches. If you eat larger meals, weight loss may stop. This can happen if the stomach pouch is too large or you don't follow post-surgery instructions.
• Weight regain: Weight gain usually starts in the third year after surgery. Patients who don't change their habits may gain back some or all of the weight they lost.
• Malnutrition: Malnutrition (failure to get adequate nutrition) is serious. Some patients have trouble getting enough nutrients when they eat fewer calories, especially if they have diarrhea or nausea. Your healthcare provider may suggest vitamins and minerals, medication, or other things to help you stay healthy.
• Food intolerance: After gastric sleeve surgery, patients can't eat as much food at one time compared to before. This can cause trouble digesting certain foods, like red meat, rice, pasta, and bread.

Side Effects

Some gastric sleeve patients develop stomach problems. These may happen just after surgery and can last for a long time. Some patients may also have sagging skin after losing weight.

Indigestion

Some gastric sleeve patients may notice an increase in indigestion or upset stomach. This might be because of the smaller stomach size. It could also be because of changes in the way food moves through the body.

Nausea

Nausea is a common gastric sleeve complication. Most people notice that nausea improves as they recover, but some people have it for months or longer.

It's not clear why some gastric sleeve patients have nausea. It might be partly because food stays in your stomach longer. Nausea medications may be helpful.

Diarrhea

Some patients may have diarrhea after surgery. This may happen for a few reasons. The microbiota (bacteria in your gut) may change after surgery. Undigested nutrients in your small bowel may also cause diarrhea.

Diarrhea can cause dehydration or malnutrition. If diarrhea doesn't go away on its own, your surgeon or a gastroenterologist may be able to help.

Sagging Skin

When you gain excess weight, your skin stretches. This is why sagging skin is so common after any weight loss surgery. A panniculectomy is a surgery to remove excess skin. Your surgeon may want to wait until your weight has been stable for one to two years before recommending this.

Long-Term Gastric Sleeve Complications

Gastric sleeve surgery can cause mild to severe long-term complications. This means they may last for up to six months after surgery. They may also appear up to six months after surgery.

Talk to your healthcare provider if you're worried about developing a medical problem after surgery.

Gastroesophageal Reflux Disease (Acid Reflux) 

Heartburn and other symptoms of gastroesophageal reflux disease (GERD) are common after this surgery. Symptoms include:

• Bloating
• Feelings of fullness
• Upset stomach

Acid-reducing medication can help improve GERD symptoms.

Stomach Ulcers

Stomach ulcers, known as peptic ulcers, are more common after this surgery. Stomach ulcers can cause:

• Dark, tarry stools
• Blood in vomit
• Pain in the stomach area

Stomach ulcers are usually found during an upper endoscopy.

Gallstones

Gallstones are more common after any weight-loss surgery. Because of this, patients sometimes need cholecystectomy. This is a surgery to remove the gallbladder.

Stomach Obstruction

Stenosis is a narrowing of the stomach outlet that makes it hard to digest food. It can sometimes block your stomach. A surgeon can fix this problem by "stretching" the narrow spot.

Abdominal Adhesions (Scarring)

The tissues of the abdomen are slippery. This helps them move when you move. After surgery, you may have scarring that makes tissues "sticky," causing a pulling feeling. It may be annoying or even painful. Sometimes, this scarring can block your small bowel.

Abscess

An abscess is a pocket-like collection of pus that forms in your body. When this happens just after surgery, it is usually because some of the contents of your intestines spilled or leaked. An abscess in the spleen, the organ that filters your blood, is a very rare complication of this surgery. 

Delayed Leak

A suture line leak, also called a suture line disruption, is when stomach contents leak through the spot that was sewn together. When this happens, it is usually just after surgery. Sometimes, though, the suture area will start leaking months or even years later.

Delayed leaks are rare, but still dangerous. They may require medications, hospitalization, or additional surgery. 

The symptoms of gastric sleeve leakage include fever, abdominal pain, peritonitis, hypotension, leukocytosis, and tachycardia (increased heart rate). In some people, tachycardia can be normal, but a healthcare provider should be notified if an increased heart rate feels worrying or accompanies any of these symptoms.

Incisional Hernia

A hernia forms when an organ pushes through a weak spot in tissue or muscle. A hernia can occur after any surgery. With laparoscopic surgeries, it is less common. Still, a hernia may develop months or years later. A hernia looks like a bulge at the site of your incision. 

Mental Health and Social Concerns

This surgery can affect your mental health and your relationships. These are important things to think about.

Addiction Transfer

For some people, food is an addiction. They may self-medicate by eating too much. Because this surgery makes it impossible to overeat, patients may form new addictions. These may include:

• Alcohol abuse
• Drug addiction
• Sex addiction

Divorce

The divorce rate in the United States is 50%. A 2018 study found that people who have had weight loss surgery have even higher divorce rates.

Weight loss can be hard on couples. A partner may feel jealous or no longer needed. This can make divorce more likely.

Healthcare providers recommend talking about these issues with your partner. Couples counseling can help, too.

Summary

Gastric sleeve surgery may cause complications. Patients can have physical symptoms that last a long time after surgery. Medical and mental health problems may also happen. It is important to discuss all the possible complications with your healthcare provider before choosing this surgery.

A Word From Verywell

Healthcare providers want surgery to be safe. One way they improve safety is by looking at 10-year outcomes. Over time, researchers track things like:

• How patients keep weight off
• How healthy they are
• What complications they have had

This surgery is relatively new. There isn't as much 10-year data on it as there is for other surgeries. This list of complications may grow over time.

You should feel good about your choice to have surgery. Your healthcare provider can explain the risks and complications. Your healthcare provider may also suggest other treatments. This will help you make the best choice for yourself.