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7 Gastric Sleeve Risks You May Not Know (Don’t miss #2)

Gastric Sleeve Surgery Risks and Complications


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Source: University of Pittsburgh Medical Centre

As with any other surgical procedure, the gastric sleeve has certain risks. However, the overall complication rates are low. The level of risks associated with this type of surgery is only 5 to 10%.2

Sleeve Gastrectomy causes with three main complications, and they are the staple line gastric bleeding, staple line gastric leaks and gastric strictures.1

The risks and complications of sleeve gastrectomy include:

1. Internal Bleeding

Internal Bleeding Post Gastric Sleeve SurgeryAccording to the study by Sarkhosh K. et al., there is a 6% risk of internal bleeding or hemorrhage.2

Common areas can be gastric staple line, liver, spleen or abdominal cavity walls.

Signs and Symptoms

  • Weakness
  • Light-headedness
  • Shortness of breath
  • Shock
  • Low blood pressure

Prevention/Remedy

  • Use of staples of an appropriate height or size
  • Performing over-sewing of staple lines
  • Sewing by hand
  • Applying pressure before firing staples
  • Staple line reinforcement. It involves buttressing the staple lines with a bio-absorbable material. This helps strengthen the staple line and compress it to prevent bleeding
  • Hemostatic agents, which increase the coagulation properties of blood, and stop blood loss internally

2. Pouch Stretching

Stretched Stomach Pouch After VSGThe stomach pouch starts to expand due to a gradual increase in the diet.

  • Eating more than the prescribed portions may result in the sleeve stretching.
  • Patient’s stomach may grow back close to its original size over a period.
  • The stretched pouch sends out wrong signals to the brain, and you end up overeating.
  • This renders the procedure useless as your hunger increases over time, causing weight to regain.

Signs and Symptoms

  • Increased appetite
  • Weight gain due to increased hunger

Prevention/Remedy

  • Avoid overeating. One meal won’t stretch your pouch. However, constant deviation from the ‘restricted portions’ diet will cause issues.
  • Follow the doctor’s advice and avoid fluids in between and right after meals. It causes additional pressure on the stomach, which results in expansion.
  • Go for a small snack in between meals in case of hunger pangs. It will make you feel full, and you can avoid overeating.

Nutritionist’s Tip:

DO NOT drink soda after bariatric surgery.

3. Blister or Abscess

Stricture and Abscess After Bariatric SurgeryAn abscess can form after bariatric procedures. It is a pocket of fluid. It develops internally in the abdominal or thoracic cavity. Bacteria infestation can cause infection and pain.

  • According to Sarkhosh K. et al., there are roughly 0.7% chances of contracting an abscess or blister.2
  • Abdominal pains, fever, and nausea are the main characteristics.
  • It may even cause vomiting.

Signs and Symptoms

  • Fever
  • Redness and heat at the place of incision
  • Increased heart rate
  • Dizziness or light-headedness

Prevention/Remedy

  • Antibiotics and thoracotomy are treatment options
  • Surgically reaching the fluid pocket to drain the fluid followed by antibiotics is another option.

4. Gastric Sleeve Leakage

Sleeve Gastrectomy Leak from PouchAccording to the report, Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent, a Roux-en-Y bypass is riskier.

However, its complications may increase morbidity and mortality rate. Gastric leak incidences vary from 0.7 to 20%.3

  • A gastric sleeve leak can delay the recovery.
  • Symptoms include shortness of breath, fever, anxiety, increase in heart rate, etc.
  • A leak can result in an infection or abscess or blood clot in the lungs.

Signs and Symptoms

  • Fever
  • Increased heart rate
  • Difficulty in breathing or altered breathing

Prevention/Remedy

  • Enteral nutrition refers to a method of feeding a person through a tube. It includes the usual oral diet and supplements.
  • Proton-pump inhibitors provide a prolonged and considerable gastric acid reduction. This decreases the potential harm caused by the leak.
  • Another remedy is placing a drain internally.
  • Biological or bio-absorbable glues can be used to stop the leakage.
  • Flexible surgery stents can be used to stop leaking.

5. Stricture

A stricture is a state in which the passage from or to the stomach gets blocked or inflamed. This causes all or some of the food to NOT enter the stomach or intestines. Strictures are common post surgery.

  • They can either be acute or chronic.
  • It is a potential occurrence after LSG.
  • Can cause food intolerance, vomiting, and nausea.

Signs and Symptoms

  • Nausea or vomiting
  • Difficulty in swallowing
  • Intolerance to food

Prevention/Remedy

A doctor will treat a stricture with the help of an endoscope. Special tools are attached to the top of this flexible tube with image sensors. A small inflatable balloon is joined to the tip to open or loosen the stricture.

  • An ulcer may also narrow down the passage. Here, patients are advised to take acid blockers. This help prevents such outgrowths and eventual bleeding.
  • It is advised to cut down on drinking alcohol and smoking.
  • In rare cases, surgery to revise the stomach-intestine connection may be an option.

6. Undernourishment

Due to the reduced size of your stomach, many micronutrients do not get absorbed well.

  • Nutritional deficiency is a common occurrence after LSG.
  • Decreased diet and reduced absorption of nutrients are common causes.

Signs and Symptoms

  • Abnormally pale or yellowish skin
  • Fatigue or lethargy
  • Hair loss after bariatric surgery
  • Light-headedness
  • Constipation or constricted bowel movement
  • Menstrual issues among women
  • Lack of concentration

Prevention/Remedy

  • Eat small meals throughout the day.
  • Opt for foods that are dense in nutrients.
  • Keep yourself hydrated.
  • Ensure you get 60 grams of protein every day. Protein supplements like shakes or other instant meal mixes are a good option.
  • Be regular with vitamins and minerals. Essential supplements are Calcium Citrate with Vitamin D, Vitamin B-12, and Iron.

Nutritionist’s Tips

  • DO NOT take calcium and iron supplements at the same time.
  • DO NOT eat fibrous foods with vitamins.
  • DO NOT take vitamin supplements on an empty stomach.

7. Gastroesophageal Reflux Disease

GERD (Acid Reflux) After Gastric SleeveIt is also called GERD, or heartburn. It is a digestive disorder of the stomach and esophagus. It causes the stomach’s contents and some acid to run back up to the esophagus.4

  • According to a WebMD report, Acid reflux is a prevalent condition among bariatric patients.
  • It may result in heartburn, vomiting or ulcers if not rectified soon.

Signs and Symptoms

  • Acid reflux to the esophagus
  • Reflux of stomach contents to the throat
  • A sore throat
  • Swollen tonsils
  • Difficulty in swallowing
  • Heartburn

Prevention/Remedy

  • Different medicines can be used to control GERD. These medicines relieve heartburn symptoms. These also help prevent them in the future.
  • PPIs are proton pump inhibitors that inhibit the production of digestive acids.
  • Antacids are helpful in stopping heartburn by neutralizing the acid in your system.
  • Some cases require surgery. It would help strengthen the barriers between the stomach and the esophagus. This would help control acid reflux.
  • Endoscopic treatments help in strengthening the muscle. Its function is to keep the content of the stomach from going into the esophagus.
  • Lifestyle changes like quitting smoking and alcohol can do wonders. Avoid spicy food, and lying down right after a meal.
  • Maintaining a healthy weight also helps reduce acid reflux problems.

An inspiring quote to help you in your weight loss journey.

Weight Loss Inspirational Quote

References

  1. Palanivelu Praveenraj, Rachel M. Gomes, et al. “Management of Gastric Leaks After Laparoscopic Sleeve Gastrectomy for Morbid Obesity: A Tertiary Care Experience and Design of a Management AlgorithmJournal of Minimal Access Surgery. 2016;12(4): 342–349
  2. Sarkhosh K, Birch DW, Sharma A, Karmali S. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Canadian Journal of Surgery. 2013;56(5):347-352.
  3. Case Report on Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent
  4. Gastroesophageal Reflux Disease (GERD) – 2015; WebMD
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Updated on December 1, 2018

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