Post-Operative problems: Gastric Sleeve

WARNING: Unpleasant symptoms occurring after Obesity Surgery can indicate a progressing and/or life threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.

EARLY PROBLEMS (the first 7-10 days after surgery)

In general the first week after surgery is an important period to monitor for problems, as the majority of complications will occur during this time. Leak and bleeding, which are the most serious problems, tend to occur just after surgery and are less likely later in this period

Bleeding

This is the most common complication after Gastric Sleeve and usually occurs within the first 24 hours. Typically this is not fast bleeding at the time of surgery (although this can occur), rather it is usually from the long staple line closure where the stomach has been divided. Significant bleeding could lead to blood transfusion or extended hospital monitoring. Symptoms of blood loss are dizziness (especially on standing), shortness of breath, a rapid pulse (> 100 beats a minute), a pale appearance and minimal or no urine production. Of course, passing blood per rectum is diagnostic; however, this can be delayed 24-48 hours after staple line bleeding. Because bleeding is fairly common we require that all patients having Gastric Sleeve stay overnight for observation.

Stomach Leak         

This is potentially a life threatening complication. Fortunately, leak after Gastric Sleeve is rare, occurring in 1 out of 100 patients. It occurs when a hole or gap develops somewhere along the staple line closure allowing stomach juice to escape into the abdominal cavity. A severe infection develops that can lead to sepsis (adverse symptoms involving all body systems) or septic shock (low blood pressure with injury to all body systems). Multiple Organ Failure can occur which is basically a shut down of many organ systems. With time this can lead to death.

Symptoms of stomach leak include: rapid heart rate, dizziness, shortness of breath, fever, worsening abdominal pain, left chest or shoulder pain, abdominal distention, the appearance of illness and a general feeling that something is very wrong. Unfortunately, many of the symptoms may be absent or could be from something else (e.g. bleeding). Diagnosing a leak is further complicated by the fact that there is no single, reliable test to definitely diagnose a leak.

The diagnosis of a leak must be clinical, that is, the surgeon must consider all symptoms in relation to the timing after surgery. The diagnosis can never be 100% sure before treatment. If a leak is suspected the patient must go back to the operating room for an OPEN SURGERY to close the hole and clean up the leak. Usually, the patient will need to spend some time in the Intensive Care Unit (ICU) and rarely may require mechanical ventilation, temporary dialysis, and/or medications to support the blood pressure. Clearly, the key factor with a bowel leak is an early return to the operating room, even if the diagnosis is not assured.          

Blood Clots

This is a rare problem which occurs in less than 1% of patients. Obese patients are more prone to developing blood clots in the veins of the legs than are normal weight patients. The clot is dangerous because if it were to break off it might travel up the blood stream to the lung where is could suddenly decrease blood flow. This is known as a pulmonary embolism and frequently is fatal. The treatment is PREVENTION of the formation of blood clots. Our patients are given a short-acting blood thinner before surgery and sequential leg squeezing devices are fitted over the legs during the operation. Although, both of these are somewhat effective, neither is anywhere near as effective as the main treatment, which is getting out of bed and walking within 2 hours of the end of the operation. EARLY MOBILIZATION is the key to preventing blood clots. It is the most important thing the patient can do for him/herself around the time of the surgery.

Abdominal Abscess

This is a very rare problem if a stomach leak has not occurred first, probably occurring in 1 out of 300-500 patients. An abscess is a collection of pus localized to one area of the abdominal space – usually under the left diaphragm. Symptoms include a rapid heart rate, fevers, and occasionally abdominal distention with or without vomiting. Usually, this will take longer to develop than a leak and will not progress as fast. An abscess can be diagnosed by CT scan and the treatment of choice is to have the radiologist place a drain into the cavity to drain the pus. Rarely re-operation will be required. The patient will need to stay in the hospital on antibiotics until the abscess clears.

Wound Infection

A wound infection is an infection of one of the incision sites, typically occurring 7-10 days after surgery. The incision will be red and warm, with thickening of the skin, sometimes accompanied by pus discharged from the wound. The patient may have fever. It should be noted that a small amount of redness along an incision is normal, and when this is not accompanied by the other signs is unlikely to be an infection. Treatment requires opening of the wound (to let the pus out), daily dressing changes of gauze to the wound base, and oral antibiotics. The patient will not need to stay in the hospital unless the infection is progressed or he/she has a vulnerability to infections (e.g. diabetes).

LONG TERM PROBLEMS (can occur any time after surgery)

Stenoses

A stenosis is a narrowed area somewhere along the tapered tube of stomach. A stenosis is thought to be from over-scarring at the site of involvement with subsequent contraction of the scar. This can lead to a very small channel only a few millimeters wide. The classic story is that the patient was initially able to tolerated solid foods, but a few weeks later started to vomit solids but could handle liquids. Later there might be progression of intolerance to soft food and later liquids.

The treatment of a stenosis is to assess the area with upper endoscopy. If necessary a balloon can be passed into the channel and used to dilate it to a larger size. This treatment is usually effective; however, an occasional patient might require serial dilatations. Although dilatations are relatively safe there is a small risk of perforation of the bowel which would require emergency Open Surgery to correct.        

Stomach Obstruction

A stomach obstruction is a blockage which leads to both vomiting and moderate to severe abdominal pain. Because the stomach is now a narrow tube that does not have its usual lateral attachments, it is possible for the tube to kink or twist leading to a blockage. This problem is thought to be very rare, and has only been reported in a few patients across the country. If this cannot be corrected with conservative therapy then an operation to untwist the stomach may be necessary.

IMPORTANT: The problems above are a partial list of all possible complications that can occur after this procedure. Some complications are rare and may be beyond the experience of the surgeon or even the surgical literature. Complications are usually not foreseeable.

WARNING: Unpleasant symptoms occurring after Obesity Surgery can indicate a progressing and/or life threatening problem that could require immediate hospitalization or surgery to control. Failure to notify the doctor immediately could result in preventable injury or death. Call 713-993-7124 IMMEDIATELY if untoward symptoms occur.