Gastric Sleeve Surgery Complications and Risks

About 20% of individuals will experience complications following gastric sleeve surgery, also known as a sleeve gastrectomy. These may range from surgical complications to a lack of weight loss and even relationship problems, and they can occur during the procedure, shortly after, or even years later.

This article covers potential gastric sleeve surgery risks. It also discusses ways to prevent complications, as well as when to reach out to your healthcare provider.

Gastric Sleeve Risks During Surgery

Gastric sleeve risks that can occur during or right after surgery include:

• Bleeding
• Pain
• Infection
• Blood clots
• Staple line leak leaks that happen in the connections made during the surgery)
• Bad reaction to anesthesia, the medications given to make you unconscious during a procedure

Gastric Sleeve Complications and Side Effects After Surgery

Some individuals may experience gastric sleeve complications and side effects following surgery. These may occur within days to months following surgery. These may improve as you recover, but some can last long-term.

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 digestive tract.

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 individuals have nausea after this surgery. It might be partly because food stays in your stomach longer. Nausea medications may be helpful.

Diarrhea

Some individuals may have diarrhea after surgery. This may happen because the balance of bacteria in your gut may change after surgery. Undigested nutrients in your small intestine may also cause diarrhea.

Diarrhea can cause dehydration or malnutrition. If diarrhea doesn't go away on its own, your gastroenterologist, or doctor who specializes in digestive disorders, 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 and can show up within months after the procedure.

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.

Stomach Obstruction

Stenosis is a narrowing of the stomach outlet that makes it hard to digest food. It can sometimes block your stomach. This tends to occur within six weeks after surgery.

A surgeon can fix this problem by "stretching" the narrow spot.

Long-Term Gastric Sleeve Complications

Gastric sleeve surgery can cause mild to severe long-term complications. These can show up within months or years post-surgery.

Talk to your healthcare provider if you're worried about gastric sleeve complications that may occur after a year or longer.

Weight Regain

Weight gain usually starts in the third year after surgery. Individuals who don't change their habits may gain back some or all of the weight they previously lost.

Food Intolerance

After gastric sleeve surgery, individuals 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 following surgery.

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.

Research indicates that around 20% to 35% of individuals experience a long-term failure rate. Failure rate is defined as a body mass index of greater than 35 within 18 to 24 months post-surgery.

Malnutrition

Malnutrition, or failure to get adequate nutrition, is serious and can show up years after the surgery. 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.

Gastroesophageal Reflux Disease (Acid Reflux)

Heartburn and other symptoms of gastroesophageal reflux disease (GERD) are common complications of gastric sleeve surgery and can show up even a year after the procedure.

Symptoms include:

• Bloating
• Feelings of fullness
• Upset stomach

Acid-reducing medication can help improve GERD symptoms.

Stomach Ulcers

Stomach ulcers, also known as peptic ulcers, are more common after this surgery and can show up months to years later.

Stomach ulcers can cause:

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

Stomach ulcers are usually found during an upper endoscopy, or a procedure that uses a flexible tube with a camera to look at the upper digestive tract.

Gallstones

Gallstones, or hard substances that form in the gallbladder, are more common after any weight-loss surgery. These tend to appear within 18 months following the procedure.

Because of this, individuals sometimes need a cholecystectomy, or a surgery that removes the gallbladder.

Abdominal Adhesions (Scarring)

The tissues of the abdomen are slippery. This helps them slide past each other when you move. Within days to years 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.

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, or minimally invasive, surgeries, which are typically performed for gastric sleeve, 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. 

Rare Gastric Sleeve Complications

Rare gastric sleeve complications can occur within weeks to years after the procedure.

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, or when the tissue that lines the abdomen becomes irritated
• Hypotension, or low blood pressure
• Leukocytosis, or high white blood cell count
• Tachycardia, or increased heart rate

Mental Health and Social Concerns

This surgery can affect your mental health and your relationships in various ways.

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, individuals may form new addictions.

Examples of other addictions include:

• Alcohol use
• Drug use
• Sex and love addiction

Relationship Issues

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 and the surgery may change the dynamics of the relationship. This can put stress on each individual, as well as the couple collectively.

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

Preventing Gastric Sleeve Complications

Before and after gastric sleeve surgery, there are considerations to keep in mind that can help prevent complications.

Before Surgery

Prior to surgery, some measures are often recommended to reduce gastric sleeve risks. These include:

• Attending a bariatric surgery education program
• Receiving nutritional counseling
• Getting psychological counseling
• Having a physical exam, blood tests, and possibly stomach imaging done
• Quitting smoking several months prior to surgery
• Stopping blood thinning medication like aspirin
• Losing some weight

After Surgery

After surgery, it's important to:

• Exercise, as this can reduce how long it takes to recover and help prevent blood clots
• Continue any breathing and/or coughing exercises that your healthcare team taught you, as these can help prevent a lung infection and increase circulation
• Stay hydrated to help with nausea
• Consider having someone help with personal hygiene, physical tasks, and emotional support
• Consider joining a support group with others who have been through a similar process

When to See a Healthcare Provider

After surgery, your healthcare provider will schedule some follow-up appointments with you to check on your progress and recovery. However, you should reach out to your healthcare provider immediately if:

• You have a fever
• You are having difficulty breathing
• You have chest pain
• Your legs are swollen or red
• You are having difficulty urinating
• Pain medication is not working effectively
• You have been throwing up for 12 hours

If in doubt, it's always best to reach out to your healthcare provider.

Gastric Sleeve Pros and Cons

Pros of gastric sleeve surgery include:

• You will likely lose weight, because you will only be able to eat about half a cup of food at a time.
• It is a permanent surgery.
• It can improve the health of individuals who have had trouble losing weight and keeping it off.
• It may help improve long-term health concerns like diabetes and high blood pressure.
• Death due to gastric sleeve surgery is rare.

However, there are cons to be aware of. It's still possible to eat too much after gastric sleeve surgery. If you do, you may not lose much weight. This procedure may not help with long-term health conditions and you may experience complications.

Summary

Gastric sleeve surgery may cause complications. Individuals can have physical symptoms that last a long time after surgery. Medical and mental health concerns may also happen.

While there are ways to reduce the risks associated with gastric sleeve surgery, it is important to discuss all possible complications with your healthcare provider before deciding to move forward.

A Word From Verywell

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 an appropriate decision.