Gastric Sleeve Risks and Complications

Gastric Sleeve Risks and Complications

Gastric Sleeve Risks and Complications

As with any other surgical procedure, gastric sleeve has certain risks and complications. However, the overall complication rates are quite low. According to a study Sarkhosh K. et al published in the Canadian Journal of Surgery the level of risks associated with this type of surgery is only 5 to 10%.

The risks and complications of sleeve gastrectomy include:

Internal Bleeding

Internal BleedingAccording to the study by Sarkhosh K. et al, there is a 1 to 6% risk of internal bleeding or hemorrhage.

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

Signs and Symptoms

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


  • Use of staples of an appropriate height or size
  • Performing over-sewing of staple lines
  • Sewing by hand
  • Applying pressure prior to firing staples
  • Staple line reinforcement; it involves buttressing the staple lines with a bio-absorbable material that strengthens the staple line and compresses it to prevent bleeding
  • Application of bio-absorbable buttressing materials for controlling internal bleeding
  • Hemostatic agents, which increase the coagulation properties of blood, hence preventing blood loss internally

Pouch Stretching

Stretched Stomach PouchThe stomach pouch starts to expand due to a gradual increase in the diet over time.

  • 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 of time.
  • The stretched pouch sends out wrong signals to the brain and you end up overeating.
  • This renders the procedure useless so your hunger increases over time and you regain weight that you had lost.

Signs and Symptoms

  • Increased appetite
  • Weight gain due to increased hunger


  • Avoid overeating. One meal is not going to stretch your pouch but constant deviation from the restricted portions diet will cause issues.
  • Follow the doctor’s advice to avoid fluids in between and immediately after meals as 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.

Physician’s Tip:

DO NOT drink carbonated drinks.

Blister or Abscess

 Stricture and AbscessAbscess can form after bariatric procedures. It is a pocket of fluid that develops internally in the abdominal or thoracic cavity. Bacteria infestation can cause infection and pain.

  • According to Sarkhosh K. et al , there are approximately 0.7% chances of contracting an abscess or blister.
  • It is usually characterized by abdominal pains, fever and nausea.
  • It may even cause vomiting. 

Signs and Symptoms

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


  • Can be treated orally by antibiotics and/or thoracotomy.
  • Surgically reaching the fluid pocket to drain the fluid followed by antibiotics in another option.

Gastric Sleeve Leakage

Sleeve Gastrectomy Leak from PouchAccording to the report, Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent by Abraham, Rizvon et al this procedure is less risky than Roux-en-Y bypass but its complications may increase morbidity and mortality rate. Gastric leak incidences vary from 0.7 to 20%.

  • A gastric sleeve leak can delay the recovery.
  • Symptoms include shortness of breath, fever, anxiety, increase in heart rate, etc.
  • A leak can eventually 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


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


A stricture is a state in which the passage from or to the stomach gets blocked or inflamed causing all or some of the food to not enter the stomach or intestines. Strictures are common after surgery.

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

Signs and Symptoms

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


A doctor will treat a stricture with the help of an endoscope. It is a flexible tube with image sensors which can be used with special tools attached to its tip. A small inflatable balloon is joined to the tip to open or loosen the stricture.

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


Due to the reduced size of your stomach many micronutrients do not get absorbed properly and are passed out sooner.

  • Nutritional deficiency is a common occurrence after LSG.
  • It is caused by decreased diet and reduced absorption of nutrients.

Signs and Symptoms

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


  • Eat small meals throughout the day.
  • Opt for foods that are dense in nutrients.
  • Hydrate yourself throughout the day.
  • Ensuring you get 60 grams of protein every day is necessary. Protein supplements like shakes or other instant meal mixes are a good option.
  • It is important to take your daily dose of vitamins and minerals. Important supplements are Calcium Citrate with Vitamin D, Vitamin B-12 and Iron.

Physician’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.

Gastroesophageal Reflux Disease

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

  • According to a WebMD report, Gastroesophageal reflux disease is a very common condition with 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
  • Sore throat
  • Swollen tonsils
  • Difficulty in swallowing
  • Heartburn


  • Different medicines can be used to control GERD, relieve heartburn symptoms and 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.
  • In some cases surgery may be required to strengthen the barrier between the stomach and esophagus to prevent acid reflux.
  • Endoscopic treatments help in strengthening the muscle that keeps the contents of the stomach from going up into the esophagus.
  • Lifestyle changes like quitting smoking and alcohol, excluding spicy and acidic foods, avoiding lying down within 3 hours of a meal, etc.
  • Maintaining a healthy weight.

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

Weight Loss Inspirational Quote


  1. 1. 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. doi:10.1503/cjs.033511.
  2. Case Report on Successful Management of a Gastric Sleeve Leak with an Endoscopic Stent
  3. Gastroesophageal Reflux Disease (GERD) – 2015; WebMD

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US-registered Bariatric Dietitian

US-registered Bariatric Dietitian
Katelyn Mock is a US-registered Bariatric Dietitian certified by the American Academy of Nutrition and Dietetics. With more than 8 years of experience in formulating and reviewing diet programs across various hospital settings, Katelyn has also served as the Lead Bariatric Dietitian for the Ohio State University Medical Center.

On-site Bariatric Nutritionist in Tijuana