Gastric sleeve surgery is one of the bariatric surgical procedures for the management of morbid obesity. In laparoscopic sleeve gastrectomy (LSG), about 80% of the stomach is resected leaving a banana shaped 20%. This significantly reduces the amount of food the stomach can hold (restrictive surgery). The greater impact, however, seems to be the effect the surgery has on gut hormones that influence some factors including hunger, satiety, and blood sugar control (“Bariatric Surgery Procedures – ASMBS,” 2017).
Laparoscopic gastric sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period (Dakwar, Assalia, Khamaysi, Kluger, & Mahajna, 2013). This method is very efficient regarding weight reduction; however, it is associated with some early and long-term complications.
Gastric sleeve is becoming a common stand-alone surgical procedure in providing treatment for morbid obesity. Of the few complications, most shared and important are staple-line bleeding, strictures (usually located at the middle or distal portion of the residual stomach), and the most severe, dangerous complication being staple-line leaks (Dakwar, Assalia, Khamaysi, Kluger, & Mahajna, 2013).
Most complications become present within the first 30-days of original surgery date, and less than 0.1% of complications are deadly.
The risk of postoperative bleeding has been reported to be between 1% and 6% after gastric sleeve. The source of bleeding can be intra- or extraluminal. Intraluminal bleeding from the staple line usually presents with an upper gastrointestinal bleed. Common symptoms include hematemesis or melena stools (Sarkhosh, Birch, Sharma, & Karmali, 2013). Extraluminal bleeding usually presents with a serial drop in serum hemoglobin levels or signs of tachycardia or hypotension. Typical sources for extraluminal bleeding include the gastric staple line, spleen, liver or abdominal wall at the sites of trocar entry (Sarkhosh, Birch, Sharma, & Karmali, 2013).
Gastric Leak along Staple Line
The gastric leak is one of the most severe and dreaded complications of the laparoscopic gastric sleeve. It occurs in up to 5% of patients following LSG (Sarkhosh, Birch, Sharma, & Karmali, 2013). In a retrospective study of patients who underwent LSG, an incidence of 5.6% was found (Frezza, Reddy, Gee, & Wachtel, 2008). It is early when it occurs within the first three days of after surgery and late if it occurs after the 8th-day post-surgery.
However, recent research has found that gastric leaks have dramatically been reduced to less than 3%.
Learn more about Gastric Leak after Gastric Sleeve Surgery – Learn Renew Bariatrics approach to gastric line leaks, and what we’re doing to minimizing your risks.
An intra-abdominal abscess is another possible complication after LSG. It usually presents with symptoms of abdominal pain, fever/chills or nausea and vomiting. If there are clinical suspicions, a computed tomography scan of the abdomen should be done to rule out the presence of intra-abdominal abscess (Sarkhosh, Birch, Sharma, & Karmali, 2013).
It could present either acutely after surgery due to tissue edema or more commonly in a delayed fashion. Presenting symptoms include food intolerance, dysphagia or nausea, and vomiting. The most common site of stenosis is at the incisura angular. An upper gastrointestinal study or endoscopy is usually diagnostic (Sarkhosh, Birch, Sharma, & Karmali, 2013).
Nutrient deficiency is another complication of bariatric surgery. This is majorly due to reduced intake and absorptive capacity. Vitamin B 12, folate, zinc, and vitamin D are the major nutrients affected.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease appears in approximately 12% of cases after laparoscopic sleeve gastrectomy. Management includes dietary and lifestyle interventions along with pharmacotherapy, but sometimes revisional surgery is needed (Hernandez & Boza, 2016).
Other non-specific complications are anesthetic complications, injury to the adjacent organs, wound infection, deep vein thrombosis, postoperative adhesive intestinal obstruction, and those related to laparoscopic procedures. These difficulties are not peculiar to LSG and can also occur in other intra-abdominal surgeries.
Laparoscopic sleeve gastrectomy has been a surgical treatment choice for morbid obesity. It is effective in reducing weight in obese patients. Though associated with a small risk of complications, a condition like gastric leak can be life-threatening if not detected and treated early.