Risk Factors for Complications During the Procedure

• Obesity
• Increasing age
• Smoking
• Poor nutritional status
• Having a chronic condition such as respiratory disease or cardiac disease

Postoperative Complications
Complications related to the surgical procedure or problems adjusting to an altered digestive
tract can occur.

Dumping syndrome is a common problem that occurs after gastrectomy. With all or much of
the stomach gone, food and fluids can pass too quickly into the small intestine, causing
symptoms including:

• Cramping
• Diarrhea
• Dizziness
• Nausea and vomiting
• Shortness of breath
• Sweating

Dumping syndrome may resolve on its own after a few months and is often be relieved by
dietary changes. Eating several small, frequent meals during the day, and eating foods higher in

protein and lower in carbohydrates usually relieves symptoms. If diarrhea and vomiting worsen,
the surgeon should be notified.

Other possible complications include:

• Complications from general anesthesia (e.g., stroke, heart attack, brain damage)
• Infection at the incision site
• Internal bleeding
• Peritonitis (i.e., inflammation of the membranes lining the abdomen)
• Pernicious anemia (caused by vitamin B12 deficiently)
• Persistent nutritional and digestive problems
• Damage to adjacent organs
• Leakage of digestive contents from the staple line can lead to serious infection.
The surgeon should be notified if any of these symptoms appear:

• Fever of 101°F or higher

• Pain not relieved by medication or comfort measures
• Pain that worsens
• Redness, drainage, bleeding, or swelling at the incision site

Complications of Sleeve Gastrectomy

The most significant complications associated with this bariatric surgery are leakage, sleeve dilation and a
number of other general problems. Let's take a look at them.

Leakage
In sleeve gastrectomy surgery, a portion of the stomach is removed and the edges of the stomach are
stapled or fixed together. Sometimes, due to intra-abdominal pressure, the staple line shows leakages and
hemorrhages. However, such sleeve gastrectomy complications can be easily treated, by conducting a
second procedure that strengthens the staple line of the sleeve.

Gastroesophageal Reflux
Gastroesophageal reflux is a medical term for stomach content flowing back into the esophagus. The
acids present in the stomach content cause irritation of the esophagus. This, in turn, leads to heartburn,
which is highly uncomfortable. It is often found to be one of the complications of laparoscopic sleeve
gastrectomy, probably because of the change in the shape of the stomach.

Gastric Fistula
The irregular, hollow and tube-like passage connecting the stomach to the wall of the abdomen is called
gastric fistula. It is created, either pathologically or by surgery. In some 3-5% of sleeve gastrectomy
cases, it comes as a post-operative result. Hence, it is another possible sleeve gastrectomy complcation. A
second surgery is required to treat the condition.

Narrowing of Stoma
Sleeve gastrectomy procedure may cause narrowing of stoma or opening between the stomach and
intestine. Another surgery may be required to fix this condition. In some cases, it can be corrected with
the help of an instrument. A dilating tube is entered from the mouth to pass through the stomach. It
expands the stoma.

Hernia
In about 15% cases of sleeve gastrectomy complications, hernia is found to be one of the problems. It is
the protrusion of an organ or its muscle through the cavity that contains it. Usually, surgery is required to
repair the condition.
Malabsorption of Vitamins and Minerals
One long-term complication of sleeve gastrectomy is difficult or malabsorption of certain vitamins and
minerals. This leads to deficiency of those particular vitamins and minerals, which further causes a
number of other disorders. Deficiency of iron results in anemia and insufficient vitamin B12 can cause
neurologic disorders. Changes in absorption of calcium, phosphates and oxalates can lead to the
formation of kidney stones. Similarly, deficiency of calcium, phosphates and vitamin D can give rise to
various bone diseases.

Other Possible Complications

Vertical sleeve gastrectomy often shows some common complications associated with bariatric surgery.
The most prominent among those is microbial infection at the wound site. Another problem topping the
list is deep vein thrombosis (DVT) or formation of blood clot in the leg. The best way to reduce the risk
of venous thrombosis in legs is to walk. There is yet another complication that is sometimes seen after
sleeve gastrectomy. This is dilation of sleeves that results in increase in the food intake capacity of the
patient.

In addition to all the complexities listed above, sleeve gastrectomy complications may include hair loss,
hair thinning, mood swings, dry skin and a general feeling of weakness. Any issues with sleeve
gastrectomy needs a high level of medical attention and care. It is never advisable to try anything on your
own. Also, strictly follow the advice and treatments as directed by your surgeon.

Possible Complications
• Damage to neighboring organs or structures, such as the gallbladder and pancreas
• Leaking from the new connection between the stomach, intestine, and/or esophagus
• Infection
• Bleeding
• Incisional hernia
• Blood clots in the vein (phlebitis) that may travel to the lungs ( embolism )
• Hematoma (accumulation of blood in the wound)
• Pneumonia and other risks of general anesthesia
After Procedure
The tissue that was removed will be sent to a pathologist for examination.

How Long Will It Take?

The surgery typically takes 1 to 3 hours or more.

Will It Hurt?
Anesthesia prevents pain during surgery. Patients typically experience pain during recovery, but
receive pain medication to relieve the discomfort.

Possible Complications
• Damage to neighboring organs or structures, such as the gallbladder and pancreas
• Leaking from the new connection between the stomach, intestine, and/or esophagus
• Infection
• Bleeding
• Incisional hernia
• Blood clots in the vein (phlebitis) that may travel to the lungs ( embolism )
• Hematoma (accumulation of blood in the wound)
• Pneumonia and other risks of general anesthesia

Average Hospital Stay

The typical hospital stay after a gastrectomy is 6 to 12 days.

Postoperative Care
You will receive instructions on when and what you can eat, and how you need to restrict your
activity. During the first few days after surgery, you may be restricted from eating. As your
stomach stretches during your recovery, you will be able to eat more at a time.If you had a total
gastrectomy, you will need to eat smaller amounts of foods more often.

It is possible that you may experience frequent heartburn , abdominal pain, and vitamin
deficiencies after your gastrectomy. Your doctor may prescribe changes in your diet,
medications, and/or vitamin supplements after your procedure.
*NURSING MANAGEMENT

• Monitor VS, I/O, bowel sound

• NPO 1-3 days NGT to suction ( don’t irrigate/remove NGT)

• Fowler’s position

• Monitor NGT output

o immediately post- op BRIGHT RED

o 12-16 hrs. post op GREENISH

o > 24 hrs. tea colored, DARK RED

• progressive diet to 6 small, bland meals/ day