Gastric Sleeve Complications
Obesity is an epidemic, especially in western cultures. Although there are many dietary therapies available, many people struggling with obesity today seem to be more responsive to surgical intervention. One of the most popular surgical procedures to help facilitate weight loss is the vertical sleeve gastrectomy, also known as sleeve gastrectomy or gastric sleeve surgery. Typically, the surgery is only performed after other weight loss attempts have been unsuccessful.
VSG involves removing approximately 80% of the stomach. The remaining part is a tube or sleeve-shaped. In addition to decreased stomach size, the procedure causes hormonal changes. Together, these changes promote weight loss. Further, hormonal changes may also help relieve some conditions associated with obesity, such as heart disease and hypertension or high blood pressure.
Before having gastric sleeve surgery, it’s important to ask questions and learn as much as possible about the procedure. This will allow you the chance to weigh out the pros and cons associated with gastric sleeve surgery and gastric sleeve complications.
In general, vertical sleeve gastrectomy surgery is an option for individuals who:
- Have a body mass index (BMI) of 40 or higher (morbid obesity)
- Have a BMI that is 35 to 39.9 (obesity), in addition to weight-related health issues, such as high blood pressure, severe sleep apnea or type 2 diabetes
To achieve and maintain weight loss after sleeve gastrectomy surgery, one must be willing to follow the guidelines associated with a healthier lifestyle. For optimum success, these changes must become a permanent part of daily living. Most surgeons require patients to participate in long-term follow-up. This follow-up includes monitoring lifestyle, behavior, nutrition habits, and any changes to medical conditions.
Before meeting with a weight loss surgeon, take the time to write down any questions about the procedure so you can ask them. Knowing the facts will help you determine if this is the best course of action for your weight loss goals.
As with any major surgery, sleeve gastrectomy poses some potential risks. Gastric sleeve complications can range from those that are immediately urgent to longer-term issues. Let’s take a look at some common gastric sleeve complications:
Short-Term Sleeve Gastrectomy Complications
- Dehydration: One of the most common gastric sleeve early complications following vertical sleeve gastrectomy is dehydration. This complication can be the result of anesthesia-related nausea and vomiting. Also, the decreased stomach size and tissue swelling that occurs after surgery make it difficult for individuals to consume enough fluids. To help reduce the risk of dehydration, bariatric healthcare providers recommend sipping liquids throughout the whole day.
- Hemorrhage: The risk of postoperative bleeding following a vertical sleeve gastrectomy is another possible complication and it has been reported to occur between 1% and 6% of patients. Common sites of post-sleeve bleeding include the stomach’s staple line, the liver, spleen, and the abdominal wall at the sites where surgical instruments were introduced.
Any time surgical instruments are used, there is a risk of accidental nicking of an organ or tissue that is not the intended mark of surgery. During the early postoperative, or recovery stage, surgical staff will monitor vital signs for any symptoms of bleeding. Additionally, many patients will leave with a surgical drain in place. This drain facilitates the removal of excess fluids (including blood or small clots) from the abdomen. In most cases, the drain is removed before the patient is discharged from the hospital.
- Infection: Over 20 million surgical procedures are performed in the United States each year. Of those surgeries, up to 5% may result in surgical site infections. Infections can cause poor wound healing, more extended hospital stays, and further treatment, such as the need for antibiotics. Close monitoring after the surgery is crucial in helping to identify signs of infection. When left unaddressed, postoperative infections may result in more severe issues, including organ failure or sepsis.
A surgical site infection is defined as an infection that occurs within 30 days of surgery, and that appears to be explicitly related to the surgical procedure. The infection may be incisional or organ/space infection. Incisional infections occur at the site of the incision. An organ/space infection affects a specific space, such as the abdomen, or an organ, like the stomach or other organs that may be manipulated during surgery.
- Pulmonary Embolism: Pulmonary embolism or blood clots are another possible complication. Blood clot formation is the body’s natural response to an injury. While the development of clots following a cut or other injury is usually harmless, there are times when clot formation can be problematic. Some circumstances, such as undergoing major surgery, can increase a person’s risk of developing dangerous clots.
For example, when a blood clot gets caught in an artery that goes from the heart to the lungs, this is known as a pulmonary embolism. The blood clot blocks normal blood flow, which can result in damage to the lungs and decreased oxygen levels in the blood. If the condition is not resolved, the lack of oxygen can result in harm to other organs in the body, as well.
To help prevent a pulmonary embolism, it's vital to get post-surgery patients moving as quickly as possible. Some surgeons may also order medication to help prevent clot formation, such as heparin. Individuals who have limited mobility before surgery is at increased risk of developing clots.
- Staple line leak: A potentially severe gastric sleeve complication is staple line leakage. Healing problems due to diabetes, smoking or infections, technical errors are the potential underlying causes of this complication.
Long-Term Gastric Sleeve Complications
- Stricture: Formation of a stricture is another potential gastric sleeve complication. In some cases, a stricture may occur suddenly as a result of tissue edema (swelling) following surgery. For others, it may be a delayed response to tissue healing and scar tissue.
Symptoms of a stricture include difficulty swallowing, nausea, and vomiting. Treatment depends on when the stricture occurs. For example, if a stricture occurs shortly after surgery, allowing the bowel to rest by restricting food intake and promoting hydration may be helpful. If a stricture occurs and there are no other immediate conditions, such as a leak or abscess, it will likely resolve on its own with no need for further medical intervention.
However, if the stricture does not resolve without treatment, further intervention may be necessary. These interventions may include dilating (stretching) the area that is constricted or surgically correcting the stricture.
- Nutritional deficiencies: The goals of bariatric surgery include maximizing weight loss and achieving and maintaining nutritional health. This goal also means preventing dietary deficiencies.
Lifelong nutritional support is key to the success of patients who undergo bariatric surgery. Following surgery, patients are at increased risk for deficiencies, which can have long-term results of anemia, osteoporosis, or other health conditions. Deficiencies often occur because of several factors, including reduced dietary intake, inadequate supplementation, and malabsorption of consumed nutrients.
Sangeeta Kashyap, MD, associate professor of medicine at the Cleveland Clinic Lerner College of Medicine and a staff physician at the Cleveland Clinic’s department of endocrinology, states, “It’s important for bariatric patients to, at least twice a year, get vitamin levels checked because they may not be immediately present with symptoms of deficiencies.”
Symptoms are often not recognized or are overlooked, because losing weight and experiencing improvements in other obesity-related issues, causes individuals to feel much better after surgery. Unfortunately, the feelings of improved health post-surgically often overshadow the understanding that sleeve gastrectomy is a permanent body change. Because of these changes, absorption and processing of vitamins are not as easy as before surgery.
- Gastroesophageal Reflux Disease (GERD) - This condition occurs when weak muscles allow food and acids to move back up into the esophagus. One of the most common symptoms of GERD is heartburn. GERD is uncomfortable and sometimes painful. If left untreated, it can cause damage to the esophagus.
If heartburn occurs two or more times weekly, chances are the issue is associated with GERD, and not a simple case of indigestion. Some symptoms of GERD include trouble swallowing, continually needing to clear the throat, wheezing, laryngitis, and chest pain.
People who are obese and whose Body Mass Index (BMI) increases are more likely to develop GERD. While weight loss may help relieve symptoms of GERD, some individuals either develop or notice an improvement in GERD symptoms. Gastric bypass often resolves symptoms of GERD in patients. However, after a sleeve gastrectomy, GERD symptoms may continue or worsen. Therefore, it is not generally recommended that individuals with severe GERD have VSG.
Anyone who has had weight loss surgery and experiences GERD symptoms should notify their surgeon right away. For many, the only way to relieve symptoms is to eat something to “settle the stomach.” This fact can, unfortunately, lead to decreased chances of long-term weight loss success. It is much more beneficial to address symptoms as soon as they occur.
- Regain: While regain of weight may not be what some consider a “surgical complication,” it can result in long-term weight-related complications, an increased risk of developing secondary medical conditions, also called comorbidities, such as heart disease, high blood pressure, and diabetes.
Weight gain can occur if recommended lifestyle changes are not followed. For example, frequently snacking on high-calorie foods could result in a stall in weight loss or regain.
Following the recommended dietary intake and participating in regular physical activity and exercise can help reduce the risk of regain following gastric sleeve surgery. Also, it’s imperative to keep follow-up appointments so that your physician can monitor your progress.
As with any surgical procedure, there are potential gastric sleeve complications associated with the surgery. It’s important to discuss your weight loss goals with your doctor and to consider why you feel weight loss surgery could be helpful. Evaluating your personal needs and weighing the risk of complications against the potential benefits should help you decide if sleeve gastrectomy surgery is the best option for you.