Obesity Treatment Gastric Sleeve Surgery Complications and Risks A range of physical and mental issues can occur even years after the procedure By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FN LinkedIn Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine. Learn about our editorial process Updated on June 09, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Scott Sundick, MD Medically reviewed by Scott Sundick, MD LinkedIn Scott Sundick, MD, is board-certified in general surgery and vascular surgery. Since 2012, he has practiced with The Cardiovascular Care Group in New Jersey. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Benefits and Risks Side Effects Long-Term Gastric Sleeve Complications Mental Health and Social Concerns Frequently Asked Questions 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. Verywell / Laura Porter 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. It's still possible to eat too much after this surgery. If you do, you may not lose much weight. Your surgeon will give you a post-surgical plan. Following the plan can help reduce the risk of complications. 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: BleedingPainBlood clotsAnastomotic 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. Potential Risks of Any Surgery 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. Signs You Could Be Dehydrated 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: BloatingFeelings of fullnessUpset 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 abuseDrug addictionSex 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 offHow healthy they areWhat 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. Frequently Asked Questions What percentage of gastric sleeve procedures result in complications? About 13% of gastric sleeve surgeries result in complications. What is the risk of death from gastric sleeve surgery? The death (mortality) rate for gastric sleeve surgery is about 0.3%. This is considered low and is similar to other common surgeries. Does gastric sleeve surgery shorten lifespan? One study compared the life expectancy of obese patients who did and didn't have bariatric surgery. The life expectancy for the bariatric surgery patients was three years longer than the other group, but five and a half years shorter than the general population. Learn More: Bariatric Surgery and Heart Attack Prevention How many years does gastric sleeve last? Gastric sleeve is a permanent procedure. It lasts for the rest of your life and can't be reversed. Is there anything I should avoid after gastric sleeve surgery? To reduce risks, you may have to avoid or limit:AlcoholSmokingSugary and starchy foodsYour healthcare provider will give you instructions and advice on settling into life post-surgery. Was this page helpful? Thanks for your feedback! Get nutrition tips and advice to make healthy eating easier. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 24 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Karmali S, Johnson Stoklossa C, Sharma A, et al. Bariatric surgery: a primer. Can Fam Physician. 2010;56(9):873-9. Böckelman C, Hahl T, Victorzon M. Mortality following bariatric surgery compared to other common operations in Finland during a 5-year period (2009–2013). A nationwide registry study. Obes Surg. 2017;27:2444–2451. doi:10.1007/s11695-017-2664-z Ma IT, Madura JA. Gastrointestinal complications after bariatric surgery. Gastroenterol Hepatol (N Y). 2015;11(8):526-35. Gletsu-Miller N, Wright BN. Mineral malnutrition following bariatric surgery. Adv Nutr. 2013;4(5):506-17. doi:10.3945/an.113.004341 Kvehaugen AS, Farup PG. Changes in gastrointestinal symptoms and food tolerance 6 months following weight loss surgery: associations with dietary changes, weight loss and the surgical procedure. BMC Obes. 2018;5:29. doi:10.1186/s40608-018-0206-4 Arndtz K, Steed H, Hodson J, Manjunath S. The hidden endoscopic burden of sleeve gastrectomy and its comparison with Roux-en-Y gastric bypass. Ann Gastroenterol. 2016;29(1):44-9. Carabotti M, Silecchia G, Greco F et al. Impact of laparoscopic sleeve gastrectomy on upper gastrointestinal symptoms. Obes Surg. 2013;23(10):1551-1557. doi:10.1007/s11695-013-0973-4 Halliday TA, Sundqvist J, Hultin M, Walldén J. Post-operative nausea and vomiting in bariatric surgery patients: an observational study. Acta Anaesthesiol Scand. 2017;61(5):471-479. doi:10.1111/aas.12884 Albany Medical College. U.S. National Library of Medicine. Botulinum Toxin Pyloroplasty to Reduce Postoperative Nausea and Vomiting After Sleeve Gastrectomy. Ramadan M, Loureiro M, Laughlan K, et al. Risk of dumping syndrome after sleeve gastrectomy and Roux-en-Y gastric bypass: early results of a multicentre prospective study. Gastroenterol Res Pract. 2016;2570237. doi:10.1155/2016/2570237 Borbély Y, Osterwalder A, Kröll D, Nett P, Inglin R. Diarrhea after bariatric procedures: Diagnosis and therapy. World J Gastroenterol. 2017;23(26):4689. doi:10.3748/wjg.v23.i26.4689 Aldaqal SM, Makhdoum AM, Turki AM, Awan BA, Samargandi OA, Jamjom H. Post-bariatric surgery satisfaction and body-contouring consideration after massive weight loss. N Am J Med Sci. 2013;5(4):301-5. doi:10.4103/1947-2714.110442 Macgregor AM, Pickens NE, Thoburn EK. Perforated peptic ulcer following gastric bypass for obesity. Am Surg. 1999;65(3):222-5. Sioka E, Zacharoulis D, Zachari E, et al. Complicated gallstones after laparoscopic sleeve gastrectomy. J Obes. 2014;468203. doi:10.1155/2014/468203 Levy JL, Levine MS, Rubesin SE, Williams NN, Dumon KR. Stenosis of gastric sleeve after laparoscopic sleeve gastrectomy: clinical, radiographic and endoscopic findings. Br J Radiol. 2018;91(1089):20170702. doi:10.1259/bjr.20170702 Tabibian N, Swehli E, Boyd A, Umbreen A, Tabibian JH. Abdominal adhesions: A practical review of an often overlooked entity. Ann Med Surg (Lond). 2017;15:9-13. doi:10.1016/j.amsu.2017.01.021 Singh Y, Cawich S, Aziz I, Naraynsingh V. Delayed splenic abscess after laparoscopic sleeve gastrectomy. BMJ Case Rep. 2015;bcr2014208057. doi:10.1136/bcr-2014-208057 Praveenraj P, Gomes RM, Kumar S, et al. Management of gastric leaks after laparoscopic sleeve gastrectomy for morbid obesity: A tertiary care experience and design of a management algorithm. J Minim Access Surg. 2016;12(4):342-9. doi:10.4103/0972-9941.181285 Abou Rached A, Basile M, El Masri H. Gastric leaks post sleeve gastrectomy: review of its prevention and management. World J Gastroenterol. 2014;20(38):13904-13910. doi:10.3748/wjg.v20.i38.13904 Al-Sanea O, Al-Garzaie A, Dernaika M, Haddad J. Rare complication post sleeve gastrectomy: Acute irreducible paraesophageal hernia. Int J Surg Case Rep. 2015;8C:88-91. doi:10.1016/j.ijscr.2015.01.040 Li L, Wu LT. Substance use after bariatric surgery: A review. J Psychiatr Res. 2016;76:16-29. doi:10.1016/j.jpsychires.2016.01.009 Bruze G, Holmin TE, Peltonen M, et al. Associations of bariatric surgery with changes in interpersonal relationship status: Results from 2 Swedish cohort studies. JAMA Surg. 2018;153(7):654–661. doi:10.1001/jamasurg.2018.0215 Carlsson LMS, Sjöholm K, Jacobson P, et al. Life expectancy after bariatric surgery in the Swedish obese subjects study. N Engl J Med. 2020;383(16):1535-1543. doi:10.1056/NEJMoa2002449 American Society for Metabolic and Bariatric Surgery. Life after bariatric surgery. Additional Reading Diamantis T, Apostolou K, Alexandrou A, Griniatsos J, Felekouras E, Tsigris C. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2014;10(1):177-183. doi:10.1016/j.soard.2013.11.007 Madura J, DiBaise J. Quick fix or long-term cure? Pros and cons of bariatric surgery. F100 Medicien Reports. 2012; 4. doi:10.3410/m4-19 Trastulli S, Desiderio J, Guarino S, et al. Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials. Surgery for Obesity and Related Diseases. 2013 Sep-Oct;9(5):816-29. doi:10.1016/j.soard.2013.05.007