Gastric sleeve complications: Causes, treatments and prevention

Chapter 5

Despite being highly unlikely, it’s natural to feel anxious about gastric sleeve complications. If you’re here, you probably are afraid and worried or you think you may be going through some complications. Our goal for this article is to let you know they are easily preventable. And if they occur, acting on the symptoms promptly can help to prevent the development of further health problems.

In this chapter, we will discuss some possible gastric sleeve surgery complications, along with warning signs to watch out for. Remember that possible side effects or some problems can be expected and are normal, but should not be mistaken for complications.

Gastric sleeve complications can be caused by the patient’s pre-existing health condition, the procedure itself, or post-surgical behavior. The complications can be GERD (Gastroesophageal reflux disease), leakage, stricture, hiatal hernia, wound infection, abdominal abscess, and blood clotting

gastric sleeve complications

Stomach-related complications

Let’s talk about the potential complications of the gastric sleeve that occur in the stomach. These gastric sleeve complications must be taken care of as soon as possible. If ignored or neglected, they can become even more dangerous.

Gastric sleeve long-term complications can be manageable or can be treated. These can be done either via medicine, non-invasive treatments, or revision surgery. No matter the course of action taken, the patient must receive treatment to prevent their stomach issues from worsening. Especially after gastric sleeve surgery, you need to take good care of your stomach.

GERD aka Acid Reflux

Gastroesophageal reflux disease (GERD) is a troublesome complication of gastric sleeve. It may start as acid reflux at first. After a while, the stomach acid goes up the esophagus chronically. This irritates the esophagus over time.

To prevent GERD after gastric sleeve from developing, you will be taking a stomach protector medicine for 6 months after surgery. These medicines help with balancing acid levels in the stomach and help relieve the symptoms of heartburn, acid reflux, and dysphagia.

Other preventative methods are: avoiding eating too much, avoiding eating fast, and avoid eating foods that you are not allowed to eat; such as high-fat foods like fried food.


A leak is basically an opening on the staple line on the stomach. The possibility of a leak happening after the gastric sleeve is scarce. It can be seen in only 1,5% 5% of gastric sleeve surgery patients.

To prevent leakage from happening, your surgeon applies tissue glue on the staple line on your stomach. You will also be inserted a drain. This will prevent any harm to your organs in the case of leakage. You will be observed closely during your 2-3 days of hospital stay. You will be given serum for nutrition and rehydration. This way we will be giving the stomach some time to heal, and this helps prevent leaking.


Stricture is the narrowing of the pylorus, the part where the stomach and small intestine are connected. Due to the narrowing, the food the patient consumes has a hard time passing through the pylorus. This complication can be acute or chronic.

To prevent stricture to occur, the surgeon does not narrow the pylorus excessively. During the immediate recovery period, you will need to stay away from consuming alcohol and smoking for a while. Oedema can also trigger a stricture. That is why it is important to stay hydrated.

Hiatal hernia

The diaphragm is not only the respiratory muscle, it also separates the upper body from the abdominal area. The esophagus, however, needs to pass through the diaphragm to reach the stomach. That is why there is a hole in the diaphragm that’s called esophageal hiatus. And a hiatal hernia is when the stomach or intestine sticks out of the esophageal hiatus into the chest cavity.

To avoid a hiatal hernia from happening, you need to avoid lifting heavy stuff and protect your surgical site from any kind of trauma. And if you were previously diagnosed with GERD, you should consult your surgeon for treatment because these factors can cause this complication to occur.

Avoidable complications with proper care

As we said before, patients need to take care of themselves and follow their post-op instructions properly. We are suggesting these instructions for you to have a safe recovery and remain in good health. This way, we can get ahead of Vertical Sleeve Gastrectomy surgery complications.

Let’s see what these complications are and how to prevent them!

Your wound might get infected

If a patient’s immune system is weaker, they might be more prone to infections. After the surgery, as the patients will be eating way less, they might be malnourished if they are experiencing some of the side effects. This can also weaken the immune system. It can also occur when:

  • The patient does not take their antibiotics
  • The wounds are not dressed long enough and are exposed too early
  • The patient already had an infection in their body and did not decrease their sugar and fat intake before surgery


To prevent infections, you need to try to limit your calorie and sugar intake before the surgery. During and after the surgery, you will be given antibiotics to avoid infection from happening. You will use the antibiotics for 10 days after being discharged. Also, the incision that has the drain in it will be bandaged so that it is not exposed to bacteria.

Also, everything used and worn during the surgery is either disposable or thoroughly cleaned by surgical technologists before surgery. And your stomach will be cleaned via antiseptics so that the bacteria present in the stomach cannot enter through the incisions.


If the patient has an infection on the surgical site, they may exhibit the following symptoms:

  • Redness on the surgical site
  • Fever
  • Stomach Pain

After the surgery, the patient may experience fluid buildup. And if bacteria gets into that fluid, it turns into an infection.

Infection may occur within 30 days after sleeve gastrectomy. Infection may be at the incision site; may be superficial; or in the stomach. If the infection is in the stomach, it needs to be dealt with as soon as possible.


To treat the infection, the patient will be given antibiotics. There will be no need for further intervention if the antibiotics are working. If they do not, the surgeon might need to drain the infection out of the patient’s abdomen.

You might have abdominal abscess

An abdominal abscess is an infected fluid packet inside an inflamed tissue in the abdomen. It can form in the stomach, the liver, or other organs. An abdominal abscess is an extremely rare complication among gastric sleeve complications because the antibacterial effect of stomach acid is strong enough to prevent abscesses.

The infection we mentioned above can happen because of fluid buildup around the surgical site. If it meets with bacteria, it becomes infected. And if that infection is not treated, it can develop abdominal abscesses.

To prevent an abdominal abscess, the doctor starts with preventing any possible infections since an abdominal abscess is a product of infection. In order to do that, you will be given antibiotics. Shortly, every preventative method used for infection will help with the prevention of abdominal abscesses.


Abscess may affect the body a little more than an infection. The symptoms of an abdominal abscess can be the following:

  • Fever
  • Redness and heat around the incisions
  • Abdominal pain
  • Leukocytosis (a higher-than-normal amount of white blood cells, meaning the body is fighting an infection)

Diagnosis and Treatment

Abdominal abscesses can be diagnosed via CT SCAN. To treat them, the surgeon will drain the infection. After that, the patient will be given antibiotics.

Abscess can also be splenic. This is a one-in-a-million-kind of occurrence among abdominal abscesses. If drainage and antibiotics do not work; if the abscess is constantly recurring and/or if there are numerous abscesses, surgical intervention may be required. The patient may need a splenectomy. This is a totally safe procedure. With this surgery, the spleen will be removed. 

You may get blood clotting

After a sleeve gastrectomy, the body will start the healing process. This means the body will increase blood clotting. Our bodies do this to heal injured tissue.

However, if it is excess, blood clots can block blood flow. This may cut off the oxygen supply to different parts of the body. Sometimes clots can separate from their places and travel through the veins. If they get stuck, they can cause embolism. The occurrence rate of thromboembolism is uncertain. But, according to a study based on people who got their bariatric surgeries in 1987-2005, it has been seen in 8 patients out of 402 bariatric patients. These 8 patients were older than other patients, meaning they had more limited mobility.


Severe blood clotting is a very rare occurrence because you will be given blood thinners during your hospital stay. Also, you will be mobilized as soon as you are able to. This helps blood flow and will prevent excessive blood clotting.

Clots usually form in the legs. To prevent that, we also provide our patients with surgical stockings. These will greatly decrease the formation of blood clots by applying pressure on the leg.

However, after being discharged, you should not wear anything that feels tight on you. This will disrupt the blood flow. Wear oversized clothing, or soft clothing that does not wrap your body tight, such as pajamas and comfy sportswear.

Of course, there are other factors that can contribute to blood clotting. Smoking increases clotting and can delay recovery. That is why it is not recommended for patients to smoke for at least 3 months after surgery.

Also, if you cannot take blood thinners, a filter (vena cava filter) is inserted into the body’s largest vein, the vena cava. This filter prevents blood clots from reaching the lungs.


Blood clots can form and/or travel in different parts of the body. And the symptoms of each part can differ. Let’s review:

Gastric sleeve patients may also exhibit other symptoms, such as:

  • Low blood pressure
  • Discoloration of the lips 
symptoms of blood clotting


If blood clots have already formed, the patient will be given thrombolytic drugs. These drugs break up and dissolve blood clots.

There is a treatment method that requires a little more invasiveness: catheterdirected thrombolysis. The doctor inserts a catheter into the vein that has the blood clot in it. After that, the doctor injects the medicine directly into the clot with the catheter to break it up and dissolve it.

Chopra T, Zhao JJ, Alangaden G, Wood MH, Kaye KS. Preventing surgical site infections after bariatric surgery: value of perioperative antibiotic regimens. Expert Review of Pharmacoeconomics & Outcomes Research. 2010;10(3):317-328. doi:10.1586/erp.10.26

Sarkhosh K, Birch DW, Sharma A, Karmali S. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide. Canadian Journal of Surgery. 2013;56(5):347-352. doi:10.1503/cjs.033511

Aoun R, Gabriel M, El Haddad E, Noun R, Chakhtoura G. Splenic Abscess after Sleeve Gastrectomy. Case Reports in Medicine. 2020;2020:1-4. doi:10.1155/2020/4850675

Mala T, Søvik TT, Schou CF, Kristinsson J. Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass. Surgery for Obesity and Related Diseases: Official Journal of the American Society for Bariatric Surgery. 2013;9(2):234-237. doi:10.1016/j.soard.2011.12.014

Froehling DA, Daniels PR, Mauck KF, et al. Incidence of Venous Thromboembolism After Bariatric Surgery: A Population-Based Cohort Study. Obesity Surgery. 2013;23(11):1874-1879. doi:10.1007/s11695-013-1073-1

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