Sleeve Gastrectomy – Short Term Complications

A leak in the staple line after a Sleeve Gastrectomy is without question, the most devastating surgical complication in all of weight loss surgery.  A leak allows for the bacteria to escape from the intestinal tract into the abdominal cavity resulting in a dangerous infection that results in sepsis.  While they can occur after gastric bypass as well, they are slightly more frequent after a Sleeve Gastrectomy and are much more difficult to treat. Thankfully, leaks after either procedure occur in less than 1 in 200 patients.

A leak after a Sleeve Gastrectomy is usually the result of a sleeve that is too tight that causes the pressure inside the sleeve to build up and ultimately burst the staple line, typically at the very top of the sleeve where the stomach is the thinnest and the pressure is the highest.  Because the pressure is high inside the sleeve, repairing a leak is not a simple matter of suturing the hole closed since it will just reopen again. The analogy that I use with my patients is that repairing a leak after a sleeve is like trying to seal a connection between two garden hoses when someone is stepping on the hose downstream.  No matter how tightly you make the connection, the downstream blockage increases the water pressure forcing the water to leak out through even the tiniest pinhole.

While leaks after gastric bypass have a 90% survival rate, leaks after a sleeve gastrectomy require much longer treatment in the hospital with the need for multiple subsequent procedures and have a much lower survival rate.  Thankfully, these occur very infrequently and have decreased nearly fivefold over the last few years as surgeons have learned the pitfalls of making the Sleeve too tight, particularly at the midportion of the stomach.

Every patient who undergoes weight loss surgery understands that the risk of complication is very low, but not zero.  While leaks and other severe complications can and do occur, they are very rare events. Even the most severe complications are often fully treated within a month or so of surgery and do not result in any long term or permanent disability.  The complication rate of weight loss surgery is very similar to other procedures like appendectomy and Cesarean Section. While we understand that all surgery presents the risk for complications, problems after weight loss surgery are typically judged more harshly than after other procedures.  This is likely because the public continues to look at weight loss surgery as “taking the easy way out,” rather than as a procedure that extends lives and dramatically improves the quality of life of the patient. For every devastating weight loss surgery complication, there are dozens and dozens of patients who never experience heart attacks, kidney failure, strokes and even cancers that result from untreated obesity.  Study after study that compares those who suffer from obesity demonstrates that the health benefits of weight loss surgery strongly outweigh the complications of these surgeries.

I discuss the potential for complications with every prospective weight loss surgery patient from the very beginning of the process, but find very few in whom the risk of surgery outweighs the potential benefits.  If you become consumed with fear over the risk of complications, make sure you also consider the problems that can occur if you don’t turn your health around and take the critical steps necessary to control your weight and your future health.  Statistically, your risk of suffering a complication from diabetes, heart and lung disease or even developing an obesity related cancer of the breast, prostate, colon or ovary far outweighs the risk of you having a surgical complication.

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