Long-Term Complications After Gastric Sleeve Surgery

Gastric sleeve surgery, also known as a sleeve gastrectomy, is a weight loss surgery. During this surgery, the surgeon removes about 80% of the stomach. This surgery is usually done laparoscopically. This means the surgeon inserts instruments through small incisions in your abdomen.

Like all surgeries, gastric sleeve surgery can be risky. Patients may experience a wide range of complications, or problems that happen after surgery. These can include physical or mental complications.

After gastric sleeve surgery, the stomach or "pouch" can only hold about 4 ounces or 120 milliliters of food. This is much less than a stomach can normally hold. Some complications can happen because of this smaller stomach size.

This article will discuss some of the complications that can happen after gastric sleeve surgery. This includes short-term and long-term complications, and problems that may be physical or mental.

What Are Gastric Sleeve’s Risks and Benefits?

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.

This surgery is permanent. It can improve the health of obese people who have had trouble losing weight and keeping it off. The safety of gastric sleeve and other weight loss surgeries is similar to other kinds of surgeries.

Deaths from this surgery are rare. It has few complications when performed by a skilled surgeon. When complications do happen, they can have a range of impacts. Some complications are minor. Others can be life-altering.

Acute complications are those that occur shortly after surgery. They may include:

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

These complications are long-term. This means they may last for up to six months after surgery. They may also appear up to six months after surgery.

How Gastric Sleeve Compares to Other Surgeries

Gastric sleeve is just one type of bariatric, or weight loss surgery. There are differences between each type. Discuss all the options with your healthcare provider before deciding on a surgery. This will help you make the best choice.

Keep these two things in mind:

• A gastric sleeve is permanent. This is different than the gastric band procedure. A gastric band "cinches" the stomach to divide it into two pouches. A gastric band can be removed if there is a problem. The part of the stomach removed with the sleeve procedure cannot be replaced if there are problems.  
• You may not lose as much weight with a gastric sleeve. Compared to gastric sleeve patients, gastric bypass patients usually lose more weight. They also tend to keep more weight off in the long term. But bypass patients can have their own long-term challenges.

How Gastric Sleeve Impacts Weight and Nutrition

Weight loss is the goal of gastric sleeve surgery, but there is a chance you may not lose as much weight as you hoped. It is also possible you will lose weight but gain it back.

Because you're eating fewer calories, you're also getting fewer nutrients. That could lead to deficiencies, or a shortage of the nutrients your body needs.

Failure to Lose Weight

Sometimes the surgery doesn't help the patient lose weight. This can happen if the stomach pouch is too large. It may also happen when the patient doesn't follow post-surgery instructions. There can also be other issues that prevent weight loss.

Regaining Weight

In the first days after surgery, the stomach pouch can only hold about a half a cup of food. Over time, the pouch stretches. If you eat larger meals, weight loss may stop. You may even gain weight. 

Weight gain, if it happens at all, usually starts in the third year after surgery. Weight loss surgery is a great tool for weight loss, but patients also need to change their habits. Patients who don't permanently change their habits may gain back some or all of the weight they lost.

Nutritional Problems

Many gastric bypass surgeries change your body's ability to absorb nutrients. This does not happen with gastric sleeve surgery. Still, patients may have trouble getting good nutrition. This is because when you eat fewer calories, you take in fewer nutrients. This can be worse if you have diarrhea and nausea.

If this happens, a whole foods diet may not be enough to keep you healthy. Malnutrition, a failure to get enough nutrients, is very serious. Your healthcare provider may suggest vitamins and minerals, medication, or other things to help you stay healthy. 

Food Intolerance

You do not need to avoid certain foods after gastric sleeve surgery. This is different from other kinds of weight loss surgeries. But that doesn't mean you can eat anything you want.

A 2018 study found that gastric sleeve patients had trouble digesting some foods, such as:

• Red meat
• Rice
• Pasta
• Bread

Researchers think this is simply because patients aren't able to eat as much food at one time.

Physical Symptoms After Gastric Sleeve Surgery

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.

Dyspepsia (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 complication of this surgery. 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, or microscopic organisms 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 are obese, 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.

Medical Problems After Gastric Sleeve Surgery

Gastric sleeve surgery can cause mild to severe medical problems. Talk with your healthcare provider if you are worried about developing a medical issue after surgery.

Chronic Conditions May Not Go Away

Many patients hope this surgery will correct chronic health problems like diabetes, high blood pressure, and others. Sometimes these problems do not go away after surgery. Sometimes they go away for a while, but come back later.

Gastroesophageal Reflux Disease (Acid Reflux) 

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

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 or Social Concerns After Gastric Sleeve Surgery

This surgery can affect your mental health. It may also affect 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 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.