Is it worth it? Risks of a gastric sleeve

The benefits seem endless: easier mobility, improved fitness, improved and maybe even reversed health issues like blood pressure, sleep apnoea, diabetes and cholesterol levels as well as feeling more comfortable. But… like with any surgery, there are risks and it’s important to weigh up the risks of a gastric sleeve before deciding it is the right thing for you to do. This post is not intended to scare you, but to make sure that you can make an informed decision that is best for you.

Obviously the risks of a gastric sleeve surgery are different for everyone. Your level of risk will vary depending on your health and medical history. This is a discussion you must have with your surgeon and their team.

In 2014, a big review of studies looking at weight loss surgery complications found gastric bypass was more effective in weight loss but associated with more complications Gastric banding had less complication but lead to less weight loss and a higher re-operation rate. A sleeve seemed to be in the middle – less complications that a bypass but still a similar amount of weight loss. The main reason it has less complications is that it’s a simpler surgery to do, so there is less room for error.

The type of complications are wide and varied and may occur straight after surgery or later on down the track. Some complications are quite serious and life-threatening if not treated immediately but others are more just a hassle.

The top risks of a gastric sleeve in order of scariness are as follows:

1. Staple line leaks – A ‘leak’ occurs when the wound in your stomach doesn’t close and heal properly. Usually a leak is detected within the first 3 days, but can happen up to 30 days after the surgery. The rate in studies is anywhere from 0-10% but on average seems to be about 2%. Usually a leak will occur within the first 30 days, and if you have a leak you’ll know about it – you’ll feel awful, develop a fever and should go back to hospital immediately. Your surgeon will do a swallow to see how big the leak is and you’ll either go back into surgery to fix it, or give the gut a rest and stay in hospital until it heals itself.
2. Bleeding, blood clots and strictures are also rare but serious complications. Only 1.2% of patients experience bleeding and 0.6% of patients experience strictures. Blood clots and bleeding are usual risks of any surgery and your surgeon and anaesthetist as well as the physio at the hospital will usually do everything they can to reduce the risk.
3. Long term, you might experience reflux, gall stones and certain food intolerances. Although common, these complications are usually well managed with dietary changes or medication. Reflux is common during the first 12 months (1 in 5 patients) but reduces in the long term to about 3% after 3 years. Typical foods that you may be intolerant of are sugary or fatty foods like dairy, lollies, cake or fried foods.
4. Vitamin and mineral deficiency. It’s common to experience deficiencies in nutrients like vitamins B12 and D and iron. The volume you can eat, malabsorption and medications you might be taking are all reasons for deficiencies. Every weight loss surgery patient should take supplements daily, and have regular blood tests to check levels.
5. Finally, you might experience some nausea and vomiting. Usually nausea settles within the first few days or weeks after surgery and vomiting, especially after the first week or so, is normally related to how you eat and not a long-standing problem. If you can nail your eating habits you shouldn’t experience vomiting too often.

Statistics from here, here and here.