If you have chest pain, trouble breathing, or belly pain that is getting worse after a gastric sleeve, call 911 or go to the nearest emergency room now. Then let your surgeon know. Don’t wait to see if it passes, and don’t take extra pain medicine to cover it first.
Some pain is expected after a sleeve, mostly soreness around the incisions, and it should get a little better each day. This guide separates expected pain from warning signs, then covers the common causes of chest and belly pain after a sleeve.
In short:
- Treat new chest pain after surgery as an emergency. Call 911 or go to the nearest emergency room.
- Pain that keeps getting worse, or that your prescribed medicine doesn’t control, needs to be checked, not treated with more medicine.
- Incision soreness, mild cramping and gas pain in the first days can be part of healing, as long as they are slowly improving.
- Pain with fever, a fast heart rate, vomiting or trouble breathing needs care right away.
Chest pain: get help right away
After a sleeve, chest pain or shortness of breath can be a sign of a serious complication, such as a blood clot in the lungs, a heart rhythm problem or a heart attack, and you must be seen immediately (VA sleeve gastrectomy guidebook). Call 911 or go to the nearest emergency room if you have:
- Sudden, sharp chest pain with shortness of breath, especially after bedrest following an operation, or if one leg is swollen. This could be a blood clot that has moved to the lungs (MedlinePlus).
- Chest pain that gets worse when you cough or take a deep breath (MedlinePlus)
- Pressure, squeezing or fullness in your chest, or pain that spreads to your jaw, neck, back, arm or shoulder (CDC)
- Chest pain with sweating, nausea, dizziness, a racing heart or shortness of breath
- Chest or shoulder pain with fever, a fast heart rate or fast breathing, which can be signs of a leak (Kim and Oh, 2026)
Don’t wait to see whether chest pain is heartburn. Let the emergency team decide. Blood clots can show up after you leave the hospital: in one review, about 70 to 80% of clots after bariatric surgery were found after discharge (Kim and Oh, 2026).
Belly pain: expected vs. warning signs
Usually expected while you heal
- Soreness around your incisions, which can last for several weeks (Alberta Health Services)
- Gas pain and bloating in the first days
- Mild cramping that comes and goes and eases with rest or gentle walking
With expected pain, your medicine helps, you can drink your fluids, and you feel a little better each day.
Get help right away
Go to the nearest emergency room or call 911 if you have:
- Belly pain that is getting worse, is new or different, or is worse than when you were in the hospital (VA)
- Pain your medicine doesn’t help
- A fever, or a heart rate that stays fast
- Pain with vomiting, or you can’t keep fluids down
- Pain with vomiting and you can’t pass gas or stool
- Vomit that is red, black or looks like coffee grounds, or black stools
- Redness, warmth, swelling or thick, bad-smelling drainage at an incision
- Feeling dizzy or faint, or feeling worse instead of better
For more on cramping, see stomach spasms after gastric sleeve.
Shoulder pain after a sleeve
A sleeve is usually done laparoscopically, with small incisions. Carbon dioxide gas is used to inflate the belly so the surgeon can see. Gas left behind can irritate the diaphragm, and the pain is felt in the shoulder (Sharma and Mittal, 2016). This shoulder-tip pain often shows up in the first day or two after surgery (study of laparoscopic gallbladder surgery). Walking can help your body absorb the gas.
Shoulder pain is not always gas. Get help right away if shoulder pain is getting worse or comes with chest pain, shortness of breath, fever or a fast heart rate. These can be signs of a leak or a blood clot (Kim and Oh, 2026).
Common causes of pain in the first weeks
Incisions: Your incisions will be sore while they heal. Increasing pain, swelling, warmth, redness, red streaks, pus or a fever can mean an infection (Alberta Health Services).
Gas: Leftover gas from surgery can cause bloating and belly or shoulder pain in the first days.
Lungs: Lying in bed after surgery can lead to lung problems, including pneumonia. Symptoms include chest pain, cough, trouble breathing and fever. Walking and using an incentive spirometer as instructed help keep your lungs healthy (MedlinePlus).
Constipation: Pain medicines can cause constipation, which adds to cramping and bloating (Northwestern Medicine).
Complications: Less often, pain is a sign of a leak, bleeding or a blood clot. These are why worsening pain or pain with the warning signs above needs care right away. Read more about gastric sleeve leaks.
Pain that starts weeks or months later
Heartburn and reflux (GERD): Reflux is one of the most common long-term issues after a sleeve. It can cause heartburn, a burning feeling behind the breastbone, regurgitation, chest discomfort, chronic cough or trouble swallowing. Some people’s reflux gets better after a sleeve, some get worse, and some get it for the first time. Treatment starts with acid-reducing medicine such as proton pump inhibitors (PPIs), plus diet and lifestyle changes. If reflux doesn’t improve with treatment, converting the sleeve to a gastric bypass is an effective option (Kim and Oh, 2026). See gastric sleeve revision.
Narrowing or twisting of the sleeve: nausea, vomiting and trouble keeping down food, especially solids. It is often treated with an endoscopic balloon dilation or stent (Kim and Oh, 2026).
Gallstones: more common with rapid weight loss, usually in the first 6 to 12 months.
A blood clot in the veins near the stomach (portomesenteric vein thrombosis): more common after a sleeve than after other bariatric surgeries, usually in the first month, with vague belly pain, nausea, vomiting or diarrhea.
Ulcers: Anti-inflammatory pain relievers (NSAIDs) raise the risk of stomach ulcers, which is why they are not recommended after a sleeve (VA).
New chest or belly pain weeks or months after surgery should be checked by your doctor rather than treated as normal healing. See all gastric sleeve side effects.
Managing expected pain at home
These steps are for expected, improving pain only. If you have any warning sign above, get help instead.
- Take your pain medicine exactly as prescribed (Alberta Health Services). Don’t take extra doses or add another medicine to cover pain that is getting worse. That pain needs to be checked.
- Ask before taking any over-the-counter medicine. Don’t take two pain medicines at the same time unless your doctor told you to. Many contain acetaminophen (Tylenol), and too much can be harmful (Alberta Health Services).
- Don’t take NSAIDs such as ibuprofen (Advil, Motrin), naproxen (Aleve) or aspirin unless your surgeon tells you to (VA).
- Walk often. Getting up and moving can ease discomfort and helps prevent blood clots and lung problems.
- Use your incentive spirometer if you were given one, as instructed.
- Brace your incisions with a pillow when you cough or sneeze.
- For heartburn, eat small amounts slowly, and ask your surgeon about acid-reducing medicine. Raising the head of your bed may help.
- Ask before using a laxative or stool softener, so your surgeon can tell you the right product and dose.
Who to contact
911 or the emergency room for chest pain or any warning sign. Tell the staff you had a gastric sleeve, the date and where it was done, and your surgeon’s name. If you were treated somewhere else, ask the emergency doctor to contact your bariatric team (VA).
Your own surgeon or bariatric program for questions. If you aren’t sure whether pain is expected, call your surgeon’s office or after-hours line. Don’t wait for your next scheduled follow-up.
A doctor near home. If you had surgery away from home, have a local doctor or bariatric program you can see. Bariatric patients should have follow-up visits every few months in the first year and yearly visits with a bariatric specialist for life (ASMBS). Keep a copy of your surgery records so any doctor can see what was done.
Frequently asked questions
Is chest pain normal after gastric sleeve surgery?
Treat new chest pain as an emergency. It can be heartburn, but it can also be a blood clot in the lungs, a heart problem or a leak. Call 911 or go to the nearest emergency room, and let the doctors decide.
Why does my shoulder hurt after a gastric sleeve?
In the first day or two, it is often from gas used during laparoscopic surgery. Shoulder pain that is getting worse, or comes with chest pain, shortness of breath, fever or a fast heart rate, needs care right away.
How long does pain last after a gastric sleeve?
Incisions can be sore for several weeks, but pain should get better day by day. There is no set day to wait for. Pain that is getting worse or isn’t improving should be checked.
Can heartburn after a sleeve be treated?
Yes. Treatment usually starts with acid-reducing medicine and diet and lifestyle changes. If reflux doesn’t improve, converting the sleeve to a gastric bypass is an option.
Who should I call about pain after a sleeve?
For chest pain or any warning sign, call 911 or go to the nearest emergency room, then let your surgeon know. For other questions, call the surgeon or bariatric program that did your surgery.
If you are a Renew patient
Use the aftercare contact your Renew care team gave you. Renew patients have access to an on-call bilingual doctor after they get home. For chest pain or any warning sign, call 911 or go to the nearest emergency room first.
Sources
- U.S. Department of Veterans Affairs, Ralph H. Johnson VA Medical Center. Sleeve Gastrectomy Patient Guidebook (2024).
- Northwestern Medicine. Roux-en-Y Gastric Bypass and Sleeve Gastrectomy (January 2024).
- Alberta Health Services. Gastric Sleeve Surgery: What to Expect at Home (2025).
- Kim SH, Oh SJ. Early and Late Complications After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: A Narrative Review. J Metab Bariatr Surg. 2026.
- MedlinePlus, U.S. National Library of Medicine. Chest pain; Pulmonary embolism; Using an incentive spirometer.
- Centers for Disease Control and Prevention. About Heart Attack Symptoms, Risk, and Recovery.
- Sharma A, Mittal S. Role of Routine Subhepatic Abdominal Drain Placement following Uncomplicated Laparoscopic Cholecystectomy. J Clin Diagn Res. 2016. Also: a study of shoulder-tip pain after laparoscopic gallbladder surgery.
- American Society for Metabolic and Bariatric Surgery. Life After Bariatric Surgery.
