Diarrhea after Gastric Sleeve Surgery
Resection of the stomach along the greater curvature leaving a tubular/banana shaped portion is one of the best surgical treatments for morbid obesity. It is called sleeve gastrectomy or gastric sleeve surgery. The surgery is now done laparoscopically. This surgery markedly reduces the capacity of the stomach allowing it to accommodate a small amount of food. Once you eat a little meal, you begin to feel the sensation of fullness. The reduction in food intake is the mechanism behind the weight loss that accompanies gastric sleeve surgery.
This procedure is safer than and not as complex as other bariatric procedures. As beneficial as it is, there are complications and side effects associated with it. These include heartburn, nausea, vomiting, and diarrhea.
Diarrhea is defined as the frequent passage of loose stools.
Diarrhea is defined as the frequent passage of loose stools. It is the increase in frequency and fluidity of stool. Based on the etiology/mechanism, diarrhea can be classified as osmotic, secretory, infective, and deranged motility. More than one mechanism may be responsible for a particular case.
An osmotic diarrhea results when excess solutes are present in the intestine leading to non-absorption of water. This occurs when you ingest a substance that is poorly absorbed or when there is a deficiency in an enzyme necessary for digestion of certain carbohydrates. Fasting or avoidance of such food item leads to resolution of loose stool.
Secretory diarrhea occurs when the rate of secretion of fluid by the intestinal wall into the lumen exceeds the rate of absorption. An example of this is diarrhea of cholera which is due to toxins produced by the organism. The toxin, in turn, activates other cellular mechanisms that lead to uncontrolled water secretion into the intestinal lumen. Other causes of secretory diarrhea include laxatives, certain hormones, drugs, poisons, etc. This diarrhea does not resolve with fasting.
Infectious diarrhea is due to disruption of intestinal epithelium by viral or bacterial pathogens. This is often associated with the presence of mucus or blood in the stool. Conditions that cause increased motility in the gut may reduce the transit time preventing proper nutrient and water absorption resulting in diarrhea. Gastric sleeve surgery patients are not immune from all the other causes of diarrhea as occur in the general population. However, causes of diarrhea about gastric sleeve surgery are diet and dumping syndrome.
The first diet after the gastric sleeve is majorly fluid. This may be a cause of watery stool. It should, however, be transient lasting for few days only. However, not all patients experience watery stool after gastric sleeve surgery. Non-adherence to post-op diet may also contribute to diarrhea after surgery.
Dumping syndrome, though rare after gastric sleeve surgery is another cause of diarrhea.
Dumping syndrome, though rare after gastric sleeve surgery is another cause of diarrhea. It is a condition characterized by diarrhea, nausea, epigastric discomfort, and abdominal cramps. Other symptoms include sweating, tremor, hunger, headache, etc. Dumping syndrome is due to rapid emptying of the stomach content into the small intestine. Thus, the diarrhea is both osmotic and motility-related.
Treatment of dumping syndrome is mainly dietary adjustment. Taking a few meals at a time, delaying water intake for up to 30 minutes after meals, avoiding refined sugar, taking high fiber diets are some of the dietary adjustments used in the management of dumping syndrome. Medication such as octreotide can be used to slow down the gastric emptying and inhibit vasoactive peptide release.