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Safety guide · Sleeve gastrectomy

Gastric Sleeve Side Effects and Complications

Serious complications after a gastric sleeve are uncommon, but every surgery has risks. This guide covers the side effects you may notice in the first months, the complications that can happen later, the symptoms that need urgent care and how to lower your risk.

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The big picture

How safe is the gastric sleeve?

In US and Canadian data, serious short-term problems after the sleeve were uncommon and fell over time. The main long-term trade-off is reflux.

0.26%Of 434,030 sleeve patients had a leak within 30 days in 2018, down from 0.48% in 2015.Dang et al., MBSAQIP sleeve outcomes 2015 to 2018, Obesity Surgery, 2020
2.28%Had a major complication within 30 days in 2018.Dang et al., MBSAQIP sleeve outcomes 2015 to 2018, Obesity Surgery, 2020
0.1%Died within 30 days in a large US study, vs 0.2% after gastric bypass.El Chaar et al., MBSAQIP 30-day outcomes, 2018
31%Had reflux-related esophagitis 10 years after the sleeve, vs 7% after gastric bypass.SLEEVEPASS 10-year trial, JAMA Surgery, 2022

The first months

Common side effects as you lose weight

Your body reacts to rapid weight loss in the first 3 to 6 months. These changes are common and usually pass (Mayo Clinic).

Tiredness and body aches

You may feel tired, as if you have the flu, with body aches.

Feeling cold and dry skin

Both are common while you lose weight quickly.

Hair thinning

Hair thinning and hair loss can happen in the first months. Protein and your vitamins help.

Mood changes

Tell your care team if your mood changes. Support is part of aftercare.

Nausea, vomiting and trouble getting enough fluids can happen while your stomach heals. Small sips through the day and the staged post-op diet help. Tell your care team if you can’t keep liquids down.

The first weeks

Short-term risks after surgery

These are similar to other abdominal surgeries: bleeding, infection, reactions to anesthesia, blood clots, breathing problems and leaks from the cut edge of the stomach (Mayo Clinic).

Leaks

A leak from the staple line is one of the most serious complications. Signs include fever, a fast heart rate and worsening belly, shoulder or chest pain. Gastric sleeve leaks.

Bleeding

Bleeding along the staple line or inside the abdomen, which your care team watches for during your hospital stay.

Blood clots

Clots can form in the legs and travel to the lungs. Walking soon after surgery lowers the risk.

Infection

Red, hot or swollen skin, pain or pus around an incision. It is usually treated with antibiotics.

Months and years later

Long-term side effects and complications

What it isWhat helps
Reflux (GERD)Heartburn or acid coming up. It can be new or get worse after the sleeve. At 10 years, 64% of sleeve patients took reflux medication (SLEEVEPASS)Medication and diet changes. If it doesn’t improve, conversion to gastric bypass may help
StrictureA narrowing of the sleeve that makes solid food hard to eat and can cause nausea, vomiting and trouble swallowing (NIDDK)Tell your care team, and your surgeon will explain the treatment options
Nutrient deficienciesNot getting enough vitamins and minerals, which can lead to anemia and bone loss (NIDDK)Take your vitamins every day for life, and keep up with your labs
GallstonesStones in the gallbladder, which are more likely after rapid weight loss (NIDDK)Some doctors prescribe medicine for about 6 months after surgery to help prevent them
HerniasA hernia at an incision or inside the abdomen (NIDDK)Get checked for a new bulge or pain
Weight recurrenceRegaining weight over time. Can your stomach stretch?Nutrition support, GLP-1 medication or revision

Other long-term risks listed by Mayo Clinic include blockage, low blood sugar, malnutrition and vomiting.

When to get help

Warning signs after gastric sleeve surgery

If you notice any of these, go to the nearest emergency room. Then let the Renew care team know.

Fever or a fast heart rate

Especially with belly, shoulder or chest pain in the first weeks, which can signal a leak.

Can’t keep liquids down

Vomiting after eating or drinking, or not being able to keep fluids down.

Leg swelling or chest pain

Swelling, warmth or pain in a calf, shortness of breath or sharp chest pain can mean a blood clot.

Severe or worsening belly pain

Pain that keeps getting worse instead of better.

Signs of bleeding

Vomiting blood, black stools, or feeling dizzy or faint.

Wound changes

Redness, heat, swelling, pus or fluid leaking from an incision.

Before and after surgery

How to lower your risk

Prepare for surgery

Follow the pre-op diet and your surgeon’s instructions. See the pre-op checklist.

Take your vitamins

Every day, for life, with the regular labs your care team orders.

Follow the staged diet

Liquids first, then pureed foods, then regular foods about four weeks after surgery. Post-op diet.

Keep your follow-ups

Our nutritionists stay with you after you go home. Tell them about any new symptoms early.

Have questions about your health history?

Send it to us and our surgeons will review your risks before recommending a procedure. Virtual consultations are available.

Reviews from gastric sleeve patients

Read all patient reviews →

5-star Google reviews. Want to talk with a past patient? Ask your coordinator.

★★★★★
“I underwent the gastric sleeve surgery with Dr. Jorge Green. The surgery went very well. I had a lot of pain and soreness right after but once the IV pain meds kicked in all was right with the world.”
Sel D. · Gastric sleeve · Google review
★★★★★
“I highly recommend Dr Green with Renew Bariatrics. I had gastric sleeve surgery on 8/21/20. I received excellent medical care. Everyone was very friendly and I felt safe the whole time.”
Linda W. · Gastric sleeve · Google review
★★★★★
“Everything went so smooth it put me at peace that I chose the right people to perform my gastric sleeve. Everyone was very nice and professional, all my nurses took such good care of me and doctor Green was great.”
LaShauna S. · Gastric sleeve · Google review
Read all patient reviews →
4.9

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Frequently asked questions

What are the most common side effects of gastric sleeve?

In the first 3 to 6 months, many people feel tired, cold or achy, and notice dry skin, hair thinning or mood changes as they lose weight quickly. Nausea is also common while the stomach heals.

How common are leaks after a gastric sleeve?

Uncommon. In US and Canadian data on 434,030 sleeve patients, the 30-day leak rate fell from 0.48% in 2015 to 0.26% in 2018.

Does the gastric sleeve cause acid reflux?

It can. In the SLEEVEPASS trial, 31% of sleeve patients had reflux-related esophagitis at 10 years, vs 7% after gastric bypass. Tell your surgeon about any reflux before surgery.

Will my hair fall out after a gastric sleeve?

Hair thinning is common in the first months of rapid weight loss. Eating enough protein and taking your vitamins helps.

Do I need vitamins for life after gastric sleeve?

Yes. You take vitamin supplements for life, with regular labs to check your levels.

What should I do if I have symptoms after I get home?

If you have a fever, a fast heart rate, chest or belly pain, leg swelling or can’t keep liquids down, go to the nearest emergency room. Then let the Renew care team know.

Related gastric sleeve pages

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