Gastric Sleeve Possible Complications

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Published January 9, 2024
gastric sleeve possible complications

Many people have a lot of confidence in gastric sleeve surgery. It has been proven to be a safe and effective way of losing weight. Studies show you can lose at least 50% of excess weight in the first 18 to 24 months after the surgery.

Like any other surgical procedure, gastric sleeve comes with its fair share of complications. But ultimately, gastric sleeve wins the risk vs. reward analysis. However, it helps to be aware of these possible issues you might encounter during and after the procedure.

How Gastric Sleeve Compares to Other Surgeries

Gastric sleeve surgery is a weight-loss surgery where the surgeon removes 80% of your stomach, leaving behind a small tube-like stomach. The procedure is done laparoscopically. This means that the surgeon inserts a camera and other instruments through a small incision made in the abdomen.

The patient eats less food and gets hungrier slower with the smaller stomach size.

The new stomach typically carries 4 ounces or 120 milliliters of food. That is much less than a normal stomach would. In some cases, this is the cause of certain complications a patient might develop post-op.

Gastric sleeve is also permanent. Compared to the gastric band, the gastric sleeve procedure cannot be reversed. With the former, the band can be removed in case of complications. With gastric sleeve, the portion of the stomach removed is permanently taken out of the body.

Benefits of Gastric Sleeve

The benefits of gastric sleeve surgery far outweigh the risks. Generally, you’ll be able to effectively lose weight after the procedure. Some patients report losing up to 60lbs in the first 5 months.

After getting gastric sleeve surgery, you’ll only be able to eat about half a cup of food at a time. Since you’re eating less food than before, you’ll be taking in fewer calories, effectively leading to losing weight.

Other benefits of this procedure include:

  • Quick & Easy: Compared to gastric bypass surgery, gastric sleeve is quicker and technically easier to perform
  • Good Amount of Weight Loss: You achieve more weight loss than Lap Band and slightly less than gastric bypass
  • No Dumping Syndrome: You don’t get dumping syndrome, unlike gastric bypass
  • Rapid Weight Loss: The weight loss is rapid, with most weight being lost in the first year after the surgery.
  • No Adjustments: You don’t require band adjustments, unlike Lap Band surgery

General Risks of Gastric Sleeve

Studies show that the safety of gastric sleeve and other bariatric surgeries is similar to other kinds of surgeries. In 2010, a study at Stanford University further showed an average mortality rate of 0.8%.

But that also means that the reality of developing complications is not far-fetched. These are some risks you can expect with gastric sleeve.

  • Blood clots
  • Pain
  • Bleeding
  • Anastomotic or gastrointestinal leaks

When a skilled surgeon performs the surgery, you should expect very few complications. But when they do happen, they have a range of impacts. Some complications can be minor, while others can be life-threatening.

Moreover, some complications are long-term, meaning they can last up to six months after the surgery. Some may also appear up to six months after the surgery.

Some complications may also be caused by poor adherence to diet practices advised by the surgeon or consultant dietician. If you start frequently overeating, you may not lose much weight and develop post-op complications.

Most Common Post-Op Risks

Post-operative complications and risk can show up in a variety of times after surgery, ranging from immediately or to several weeks. In the initial two weeks post-surgery, patients are typically at a higher risk for certain complications while many other complications might manifest itself throughout the recovery period. 

It is crucial for patients to be closely monitored during the postoperative period and to maintain open communication with their healthcare providers about concerns or unusual symptoms following the surgery.

The First Two Weeks

During the first two weeks, patients are at a higher risk for complications such as infections, bleeding or issues related to anesthesia compared to that of the coming weeks and months. Immediately after surgery you are going to notice a lot of changes as you adjust to your new diet and your new normal.

Some specific complications that may occur in the first two weeks include:

Staple Line Leaks

This is the most dreaded complication during the first week after surgery. Surgeons usually test, double-check, and over-sew staple lines during gastric sleeve surgery to avoid this complication.

A staple line leak leads to a gastrointestinal leak. The common symptoms for this complication include:

  • Fever
  • Difficulty or altered breathing
  • Increased heart rate

Call your doctor immediately you experience these symptoms. Thankfully, according to a study, the risk of developing it is 2.4%.

Thrombosis (Blood Clots)

Blood cots after any surgery are usually life-threatening and should be addressed immediately. Thankfully, hospitals and physicians are fully aware of this and often take measures to prevent a blood clot from happening.

Otherwise known as a thrombus, a blood clot forms when an injury is caused during surgery to an otherwise healthy blood vessel. Clots are also more likely to form when blood flow is impaired due to a lack of mobility after surgery.

The most common symptoms of this complication include:

  • Swelling
  • Redness
  • Loss of sensation
  • Pain
  • Pale color in the affected area
  • Paralysis

Call your doctor immediately you suspect you have a blood clot. Clots can quickly lead to a stroke, heart attack, or death. Most surgeons will recommend you stay active for a short while after surgery to reduce the risk of developing blood clots.

Smokers are usually at the highest risk of developing this complication. Thankfully, the risk is very low, at 1%.


A stricture occurs when the opening to or from the stomach becomes inflamed. This may result in a blockage which will prevent all or some of the food from adequately entering the stomach or intestines.

Strictures can be chronic or acute. This means they can develop quickly or become an ongoing issue after surgery.

The most common symptoms of a stricture include:

  • Difficulty swallowing
  • Nausea or vomiting
  • Food intolerance

Call your doctor immediately if you develop these symptoms, especially if you have difficulty swallowing and you vomit or feel nauseated every time you eat.

One study has shown that strictures occur in 3.5% of gastric sleeve surgeries. Though it can be serious, often, it’s treated with a simple endoscopic dilation.

Wound Site Infection

A wound site infection is an infection at or under the area where small incisions were made for the laparoscopic gastric sleeve surgery. Wound site infections can happen after any form of surgery. Obese people carry the highest risk of developing this complication.

If not treated promptly with antibiotics, wound site infections can lead to widespread infection, tissue death, and mortality.

The common symptoms for this complication include:

  • Fever
  • Increased heart rate
  • Redness at the incision area
  • Heat at the incision area
  • Lightheadedness or dizziness

Always follow your doctor’s preoperative guidelines to take care of your wounds after surgery properly. According to this study, wound site infections are pretty common with a 10-15% rate of occurrence.

Long-Term Risks

These complications occur anytime after your surgery. They are usually not life-threatening. Still, they are not so pleasant.

Nutritional Deficiencies

Nutritional deficiencies are less common with gastric sleeve compared to duodenal switch surgery and gastric bypass. However, there’s still a risk. About 12% of gastric sleeve patients experience nutritional deficiency.

Common symptoms of this complication include:

  • Abnormally pale skin
  • Hair loss
  • Fatigue
  • Constipation
  • Lightheadedness
  • Menstrual issues
  • Trouble concentrating

Call your doctor immediately if the symptoms are severe and you cannot take the recommended supplements. Otherwise, mention this to your doctor at the next appointment.


This complication is prevalent after gastric sleeve surgery. One study shows a prevalence of 23% for most patients within two years after the surgery.

Common symptoms for gallstones include:

  • Nausea
  • Vomiting
  • Pain in the upper back and upper abdomen. The pain may last a few hours
  • Indigestion, bloating, gas, and heartburn

Go straight to the emergency room if you’re experiencing intense pain. Also, let your doctor know if you’re experiencing gas, bloating, and heartburn.

GERD (Heartburn)

It is common to have Gastroesophageal Reflux Disease (GERD) after most weight-loss surgeries. Varying evidence shows whether it increases or decreases after gastric sleeve surgery. Some studies suggest up to 47% of patients may experience it.

GERD is commonly treated through medication. Surgery may be recommended if it remains persistent.

Complications During Surgery

Many people deal with small complications during their gastric sleeve surgery. Most of the complications that surgeons encounter are effectively managed during surgery if you have a skilled surgical team. Unfortunately, there are some complications that if not adequately and efficiently addressed during the procedure, they may become evident in the first two weeks following the surgery which will result in the needs of being closely monitored. 

It is important to note that while these complications may occur, they do not happen in every case. The skill and experience of the surgical team plays a major role in minimizing risks which is why it is so important to choose your surgeon wisely. Through pre-surgical evaluations and preparations to help identify risks and potential issues, will allow for better management of risks.

Some of the potential complications that can occur during gastric sleeve surgery range from minor to severe. Some of these complications include:

Gastric leak

This occurs typically at the staple line. Qualified surgeons will use several techniques to test for leaks before finishing the surgery. They might use air, a dye test, or an EGD (Esophagogastroduodenoscopy) to better visualize the staple line from the inside.

If dealt with at this stage, the surgeon may prevent post-op gastric leaks that lead to infections and possibly death.

Unnoticed Gastric Laceration

The surgeon may accidentally cut (lacerate) the stomach without noticing. These lacerations can be properly fixed before the stomach is closed.

Other Complications During Surgery

The following can also happen during surgery:

  • Visibility Issues: Obstructed visibility due to an enlarged liver. This is common with most bariatric patients.
  • Adhesions: This is caused by internal tissues sticking together. It is common in patients who’ve had previous abdominal surgery or illness.
  • Controlled bleeding: It is normal to lose blood during surgery. It is typically not an issue if it’s controlled quickly.

Get the Full Advice of a Qualified Surgeon

The best way you can understand what is to be expected and the potential for risks is to speak with a qualified and experienced bariatric surgeon. Engaging with a specialist in the field is a necessity, as they have a wealth of knowledge specific to weight loss surgeries. During your preliminary consultations, the surgeon will not only assess your suitability for the procedure but also provide detailed insights into what the surgery entails, including the risks and benefits.  

Pre-operative advice is a critical component of this process. Your surgeon will guide you through all of the necessary lifestyle changes, dietary adjustments, and possibly recommend a pre-surgery weight loss regimen. This type of preparation is designed to reduce surgical risks and improve the overall effectiveness of the procedure. 

Not only is pre-operative care important but post-operative care is equally important. Your surgeon and their team will offer comprehensive guidance on how to manage your recovery. This included advice on diet, physical activity, wound care, and monitoring for any signs of complications. 

Find a surgeon who is willing to give you the attention you deserve for both pre and post operative care.

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