Gastric Sleeve Surgery: Understanding Potential Complications and How to Manage Them

Common Short-Term and Long-Term Risks of Gastric Sleeve Procedures

Gastric sleeve surgery, also known as sleeve gastrectomy, is one of the most widely performed bariatric procedures worldwide. While it offers significant benefits for weight loss and metabolic health, like any major surgical intervention, it comes with potential complications. These risks can be categorized into short-term (early) and long-term (late) complications, each requiring careful monitoring and proactive management.

Short-Term Complications: Risks in the Immediate Postoperative Period

Shortly after surgery, patients are closely monitored for early complications that may arise during hospitalization. One of the most serious concerns is bleeding at the staple line or within the abdominal cavity. Although rare, excessive bleeding may require blood transfusions or even a return to the operating room.

Another critical risk is leakage from the staple line (anastomotic leak), which occurs when the sealed edge of the stomach fails to heal properly. This can lead to severe infection, abscess formation, and sepsis if not promptly addressed. Symptoms may include fever, rapid heart rate, and abdominal pain, often requiring imaging tests and sometimes emergency treatment.

Narrowing of the gastric sleeve (stenosis) is another possible issue, where scar tissue causes a constriction that makes swallowing difficult. In some cases, endoscopic dilation may be needed to restore normal passage.

Additionally, patients undergoing major abdominal surgery face an increased risk of deep vein thrombosis (DVT)—blood clots forming in the legs—which can potentially travel to the lungs and cause a life-threatening pulmonary embolism. Preventive measures such as compression stockings, early ambulation, and anticoagulant medications are standard protocols in post-surgical care.

Long-Term Complications: Health Considerations Months or Years After Surgery

While many patients achieve excellent weight loss results, long-term success depends heavily on lifestyle changes and medical follow-up. One of the most common late complications is nutritional deficiency. Because the stomach is significantly reduced in size, the body absorbs fewer vitamins and minerals. Deficiencies in iron, vitamin B12, vitamin D, calcium, and folate are frequently observed, potentially leading to anemia, osteoporosis, and neurological issues.

Gastroesophageal reflux disease (GERD) may worsen or even develop after gastric sleeve surgery in some individuals. The altered anatomy can reduce lower esophageal sphincter pressure, allowing stomach acid to flow back into the esophagus. Persistent heartburn, regurgitation, and chest discomfort should be evaluated by a healthcare provider, as untreated GERD increases the risk of Barrett's esophagus and esophageal cancer.

Rapid weight loss following surgery also increases the likelihood of gallstone formation. The liver releases more cholesterol into bile during fat breakdown, which can crystallize and form stones in the gallbladder. Doctors often recommend prophylactic gallbladder removal during the initial surgery or prescribe medication to prevent this condition.

Minimizing Risks Through Proper Care and Lifestyle Choices

To reduce the chances of complications, patients must commit to lifelong dietary modifications, regular supplementation, and routine medical check-ups. A multidisciplinary approach involving bariatric surgeons, dietitians, and mental health professionals greatly enhances long-term outcomes.

In conclusion, while gastric sleeve surgery is generally safe and effective, understanding both immediate and delayed risks empowers patients to make informed decisions and take proactive steps toward a healthier future.