One of the most commonly asked questions among patients who are anticipating any surgery is, "How much pain will I experience?" Patients who have the gastric sleeve (also known as vertical sleeve gastrectomy or VSG) surgery may report post-surgical pain. Several factors may lead to pain, and, like surgeries, are unique to an individual, so is pain. In this article, we will discuss some common reasons individuals experience pain after having gastric sleeve surgery.

What Is Pain?

Pain is defined as an unpleasant or distressing feeling that is often caused by intense or damaging stimuli, discomfort caused by illness or injury. Pain is a subjective symptom, which means only the person experiencing pain can rate its depth or severity.

Many factors affect a person's perception of pain. Clinical research indicates that pain is perceived, assessed, and treated differently depending on a person's sex, race/ethnicity, and age. For example, some things that may cause an infant or young child to cry out because of pain may be more easily tolerated by an adult.

Gastric Sleeve Surgery

Vertical Sleeve Gastrectomy (VSG) is a procedure that helps to promote weight loss. At one time, the procedure was the first step in a two-phase weight loss surgery. However, now the gastric sleeve is more commonly a stand-alone procedure.

VSG involves surgically removing approximately two-thirds of the stomach and leaving a pouch or sleeve-shaped portion of the stomach. Weight loss is the result of the reduced amount of food that can be consumed following the surgery.

Gastric Sleeve Post-Operative Pain

While pain is not uncommon following sleeve gastrectomy, it is usually minimal and often short-lived. The type of pain and severity will vary from person to person.

Immediately following surgery, pain may not appear to be present at all. This is mostly because pain relievers are administered via an IV. When an individual can swallow without complications (usually the day after surgery), IV pain medications are generally replaced with oral medicines.

On the first day following surgery, pain may be moderate, but should not be severe. During this time, the anesthesia from surgery has worn off, and you should be up walking. Both of these factors can increase feelings of pain. During this time, it is essential to communicate with your physician and nurse/healthcare team so your pain level can be monitored and medication administered as needed.

The most common types of pain after sleeve surgery include:

Gas Pain After Gastric Sleeve

There are different causes of gas that may be present following sleeve surgery.

Gas is used to expand the abdomen during surgery to create more space for the surgeon to work. Within six to twelve hours following surgery, that gas can get absorbed into the body. Many bariatric surgeons use a particular device that helps to eliminate most of the gas that is introduced into the abdominal cavity so that patients experience less discomfort.

Stomach gas can be very uncomfortable, especially immediately following (and for the first several months after) surgery. The new stomach or "sleeve" is tight and inflamed. If air is swallowed, it can become trapped within the inflamed tissue of the sleeve and result in pain.

Surgical Incision Pain

Gastric sleeve is routinely done laparoscopically. When VSG is performed, the surgeon will make 5 or 6 small incisions in the abdomen. These incisions provide entry for scopes to visualize the abdominal contents and surgical tools. The most significant incision, which is where the portion of the stomach being removed, is extracted, is usually the most painful incision.

If persistent or severe pain remains at any incision site after the third post-operative day, this could indicate an infection or abscess at the surgical site. Please note: this information is not meant for use as self-diagnosis. Only a physician should diagnose and recommend treatment for any infection or abscess related to VSG.

Generalized Abdominal Pain After Gastric Sleeve

One of the most unwanted complications associated with gastric sleeve surgery, staple site leakage, is characterized by general abdominal pain after gastric sleeve. The symptoms may occur within the first few days after surgery or may present later. In addition to abdominal pain, a staple site leak may also produce symptoms such as abdominal distension, vomiting, fever, or an increased heart rate.

These symptoms require an evaluation by the surgeon to confirm if a staple leak is present. Treatment may include surgery to seal the leak and to wash out the abdominal cavity as well as pain medication and antibiotic therapy.

Chest Pain After Gastric Sleeve Surgery

One risk factor for respiratory complications is immobility. Failure to move around or prolonged stay in bed can result in a condition known as orthostatic pneumonia. The symptoms include cough, shortness of breath, fever, and chest pain.

Surgeons, nurses, and other healthcare staff will encourage patients to turn, reposition, and walk as soon as possible following surgery. This will not only help decrease the risk of pneumonia but will promote blood flow, which reduces the risk of developing blood clots.

Heartburn

Heartburn is another type of pain that is often experienced by patients who have had sleeve gastrectomy. Heartburn among sleeve patients is usually caused by gastroesophageal reflux disease (GERD). Reflux of stomach acid characterizes the condition into the lower part of the esophagus. This can lead to irritation and erosion of the esophagus.

While chest pain is not uncommon following gastric sleeve surgery, it is also a warning sign of other severe conditions and should, therefore, not be ignored.  It is necessary to report any abdominal or chest pain following gastric sleeve surgery to your doctor.

Muscle and Joint Pain

Obesity is a significant cause of muscle and joint pain. One effect of significant weight loss surgery is that the body needs to adjust to the changes that weight loss causes.

Core strength is often decreased, especially in the first few months following surgery. This weakness, combined with weight loss, can cause temporary muscle and joint pain. This type of pain is most noticeable around the hips, lower back, and knees.

Once an exercise regimen has begun, it is normal to experience some amount of soreness or muscle pain. This is normal and should not be a sign of discouragement.

In addition to weight loss and increased physical activity, nutritional changes can also result in muscle pain. Low calcium intake and a lack of vitamin D could cause the body to feel a bit different. Although the feelings may be first noticed in the digestive tract, muscle and joint symptoms may also appear. This is one reason following a post-surgical bariatric diet is very important.

Muscle and joint pain can usually be managed by eating a well-balanced diet, taking vitamins and supplements per your doctor's direction, staying hydrated, and focusing on core strengthening exercises for the back and hips.

Kidney Pain After Gastric Sleeve

Not consuming enough fluids and becoming dehydrated can cause result in kidney-related pain. Additionally, following gastric sleeve surgery, patients usually absorb less calcium from the gastrointestinal tract. As a result, some individuals will develop kidney stones. Although there is no guaranteed way to prevent kidney stones following VSG, it is possible to reduce your risk.

Hydration is an essential part of helping the body clear waste that can build up because of digestive imbalances. Therefore, consuming adequate amounts of water daily is important.

Kidney pain may begin as a dull ache, but if a kidney stone(s) is present, the pain can become much worse. If this occurs, it is vital to seek medical attention.

Pain When Eating

Gastric sleeve patients may experience stomach pain after gastric sleeve if the stomach becomes blocked by food. Food should be chewed slowly and thoroughly to prevent this from occurring. Also, some individuals find that foods that could tolerate before surgery now cause stomach pain months after gastric sleeve or general upset stomach. This is often associated with spicy foods.

How Long Will the Pain Last?

Many patients experience little to no post-operative pain or discomfort following gastric sleeve surgery. Most of the pain that is experienced is usually resolved within the first two weeks. Any pain that continues for longer than two weeks or that becomes worse or bothersome, especially if it requires taking more pain medications, should be reported to a doctor.

Pain Medications After Gastric Sleeve Surgery?

Let's face it, and no one wants to be in pain. However, after bariatric surgery, not all pain medications are not considered safe. Knowing which medicines to take and how much/how often could help prevent other issues later  on.

As mentioned above, immediately after surgery, pain medication is usually administered via IV infusion. Once the IV meds are discontinued, oral alternatives will be offered.

Over-the-Counter (OTC) Medications

Several OTC medications are used to treat pain. Following gastric sleeve surgery, it is especially important to avoid anything that would irritate the portion of the stomach that is remaining.

NSAIDs (non-steroidal anti-inflammatory drugs) are common OTC medication, "They disrupt the production of the mucus, which leads to a weakness in the mucosa layer. This thinning of the mucous lining causes healthy digestive enzymes that are present to irritate or inflame the lining of the stomach." ¹ Therefore, NSAIDs should be avoided.  Examples of this type of medication are Aspirin, Ibuprofen (Advil, Motrin), Naproxen (Naprosyn, Anaprox, All Day Pain Relief).

Pain relievers that are Acetaminophen-based, such as Tylenol, are usually approved for bariatric surgery patients.

Prescription Medications

While each doctor is different, most will offer some type of prescription pain relief for patients upon discharge from the hospital. Keep in mind, prescription pain medications are not meant for long-term use, especially after surgery. Persistent pain should be evaluated by your doctor, rather than continuously medicated.

Some prescription medications that may be offered include hydrocodone, oxycodone, morphine, and codeine. Keep in mind that all of these medications can be addictive. Additionally, they increase the risk of constipation, which can increase abdominal/stomach pain.

Conclusion: Listen To Your Body and Your Doctor

The only person who can rate the severity of your pain is you. If there is the presence of a complication, neglecting pain could cause further damage. Therefore, if you feel pain or discomfort, especially for long periods, it is crucial to consult your physician right away. Remember to keep follow-up appointments and follow your physician's guidelines for diet, exercise, and pain management.

¹: http://www.verywell.com/effects-of-medications-on-the-stomach-1942950