Gastric Sleeve Complications
Gastric sleeve complications can be categorized as early or late. Early gastric sleeve complications include leak, blood clots, bleeding, infection, dehydration, etc. Late gastric sleeve complications include acid reflux, weight regain, vitamin/mineral deficiencies, etc. Below is a discussion about leak (the most important early complication), 30-day complication rate (measure of all early complications), and acid reflux (the most important late complication).
Gastric Sleeve Leak
A leak is a serious and feared complication that can occur after gastric sleeve surgery. A leak is a hole that occurs along the surgical line of division on the stomach early after surgery (first 6-8 weeks) before complete healing has occurred. A gastric sleeve leak can result in a serious infection, the need for subsequent procedures/operations, and a prolonged hospital stay.
The good news about gastric sleeve leaks is that they are largely preventable with good surgical technique.* The bad news is that preventing leaks with good surgical technique is easier said than done.
In the early years of the gastric sleeve operation, leaks were a significant issue. Published studies reported gastric sleeve leak rates of up to 9%. Over time, as more was learned about the gastric sleeve operation, leak rates decreased (see table below).
Currently, the average leak rate for gastric sleeve surgery is around 1-1.5% (see table below).* This, however, is not the leak rate for all gastric sleeve surgeons. Some surgeons achieve lower leak rates than the average, and some achieve higher leak rates than the average.*
Sleeve Gastrectomy Leak – Published Studies*
|Author||Date Published||Study Data||Total Patients||Overall Leak Rate||Surgeon Leak Rate Range|
|Aurora et al||2012||review – 23 studies||4,888||2.4%||0-7%|
|Parikh et al||2013||review – 112 studies||9,991||2.2%||not reported|
|Gagner et al||2014||review – 88 studies||8,920||2.1%||not reported|
|Zellmer et al||2014||review – 33 studies||4,816||2.3%||not reported|
|Stroh et al||2016||Germany – bariatric registry||11,800||1.4%||not reported|
|Kumar et al||2018||MBSAQIP – 2015 data||93,062||0.8%||not reported|
|Chang et al||2018||review – 71 studies||107,874||1.2%||not reported|
* Gastric sleeve complications like leak can occur after gastric sleeve surgery. Past performance is not necessary indicative of future results. MBSAQIP – metabolic and bariatric surgery accreditation and quality improvement program.
Individual Surgeon Leak Rates
Published studies have shown a persistent and significant difference in gastric sleeve leak rates between individual surgeons, from approximately 0-4% (see table below).*
The difference between a 0% leak rate and a 4% leak rate is significant. The best surgeons report 0 leaks in many 100s of gastric sleeve operations.* The surgeons with the highest leak rates (3-4%) report 1 leak per every 25-35 operations.*
Differences in individual surgeon leak rates are largely due to differences in surgeon skill and surgical technique.*
Individual Surgeon Leak Rates*
|Author||Date Published||Number of Surgeons||Surgeon Leak Rate Range|
|Aurora et al*||2012||23*||0-7%|
|Rosenthal et al*||2012||15||0-3.9%|
|Varban et al||2017||44||0->3%|
* Gastric sleeve complications like leak can occur after gastric sleeve surgery. Past performance is not necessary indicative of future results. Aurora et al reviewed 23 studies, some of which reported on multiple surgeons, so number of surgeons is greater than 23. Rosenthal compiled data from 15 surgeons that each had done >500 gastric sleeve operations, and were considered to be the world’s top gastric sleeve experts at the time.
Gastric Sleeve Leak – Our Results
Our gastric sleeve leak rate is 0% for both first time gastric sleeve operations and revision gastric sleeve operations (e.g. LAP-BAND® revision to gastric sleeve).*
Our gastric sleeve program
Watch Dr. Oliak perform a gastric sleeve operation
Blog post – How I Do The Gastric Sleeve Operation
* Leaks can occur after gastric sleeve surgery. Past performance is not necessary indicative of future results. Dr. Oliak’s 0% leak rate is for all first time and revision gastric sleeve operations (n=400) performed 2008-2017.
Gastric Sleeve 30-day Complication Rate
30-day complication rate is a common outcomes measure for many different types of surgeries. The statistic is relatively easy to get from hospital billing data so large numbers of patients can be evaluated, and the statistic is useful medically because most surgery-related gastric sleeve complications occur within the first month after surgery.
Two recent large studies, described below, evaluated 30-day gastric sleeve complication rates.
Kumar et al, in a 2018 study, evaluated 93,062 gastric sleeve patients that had surgery in 2015, and found the overall 30-day gastric sleeve complication rate to be 5.8%. Kumar did not report on the variation in complication rates between different surgeons/programs.
Our 30-day complication rate for gastric sleeve operations performed in 2015 is 2.1%.*
Pradarelli et al, in a 2016 study, evaluated 8,693 patients who underwent gastric sleeve surgery in Michigan in 2013 and 2014, and found the 30-day gastric sleeve complication rate to be 5.4%. Pradarelli also reported that the 30-day complication rate varied by hospital from 3.6% to 11%, a 3-fold difference.
Our 30-day complication rate for gastric sleeve operations performed in 2013 and 2014 is 3.1%.*
Another recent study also reported on the variation in complication rates between different bariatric surgery programs. This study, published in 2017 by Ibrahim et al, evaluated the 30-day complication rate for serious complications at 165 accredited bariatric surgery center of excellence programs nationwide. This study, of note, looked at serious complications that occurred after any weight loss operation (gastric bypass, gastric sleeve, LAP-BAND®), not just gastric sleeve.
What the authors found was that the rate of serious complications occurring within 30 days of weight loss surgery varied 17-fold (0.6% – 10.3%) across the 165 different bariatric surgery center of excellence programs nationwide.
Our 30-day serious complication rate, using the same criteria and dates as in this study, is 0.6%.*
* Outcomes vary after weight loss surgery. Gastric sleeve complications can happen. Past performance is not necessary indicative of future results.
Acid Reflux after Sleeve Gastrectomy
Acid reflux is the main potential long-term complication after sleeve gastrectomy surgery. Minor or moderate acid reflux after gastric sleeve surgery can be controlled with antacid medications. More severe acid reflux may require an operation to address the cause (hiatal hernia), or to convert to a different operation, typically gastric bypass.
There have been many published studies on acid reflux after sleeve gastrectomy, by many different surgeons, and the results are variable. The quick summary of the published literature is that most of the time acid reflux improves with gastric sleeve surgery, but sometimes it gets worse, and occasionally it becomes severe. Different studies report different percentages for the better/worse/severe categories.
Because the published studies are quite variable in what they report, several researchers have published review studies. Review studies compile data from numerous other studies to get a more accurate big picture view.
Oor et al reviewed 33 studies on acid reflux after gastric sleeve, and concluded that surgeon heterogeneity (differences in outcomes between surgeons) between the studies was so large that estimations of overall averages could not be made.
This finding of extreme surgeon heterogeneity reflects the lack of agreement on what specific surgical techniques are required to prevent acid reflux. Different surgeons have different surgical techniques, and these different techniques translate into widely variable acid reflux rates.
Acid Reflux after Sleeve Gastrectomy – Our Results
Our gastric sleeve acid reflux rate (percentage of patients who report more heartburn symptoms after surgery than before) is approximately 16%.* The majority of these patients report their symptoms to be easily controllable and not severe.
A small percentage of patients, approximately 3%, report more severe acid reflux symptoms after gastric sleeve surgery.* The risk for more severe acid reflux after gastric sleeve surgery is highest in patients who have more longstanding/severe heartburn/gerd/acid reflux/hiatal hernia. In these patients, the chance to develop severe postoperative acid reflux can be as high as 20%.*
Patients with more severe/longstanding heartburn/gerd/acid reflux/hiatal hernia may not be good candidates for gastric sleeve surgery. In these cases, gastric bypass surgery is often a better choice, because gastric bypass surgery resolves these issues better than gastric sleeve surgery.
* Patient outcomes vary after gastric sleeve surgery. Past performance is not necessary indicative of future results.