Risks of Gastric Sleeve Gastrectomy

Obesity surgery has been practiced in the United States for many years. Surgeons who want to serve in this field, which is also called bariatric surgery, are obliged to do upper specialization. Unfortunately, many developing countries like our country do not have this upper specialization requirement for bariatric surgery. This makes this gastric sleeve surgery, which is quite safe, risky. 

In developed countries, the mortality rate is stated as 1 in 1000. The fact that this rate is slightly higher in our country is related to the lack of this specialization requirement. 

When it comes to the risks of sleeve gastrectomy surgery, the complication called leakage or leakage comes first. Especially in the thinner upper part of the staple line of the stomach, which is cut and closed with a device called stapler. opening may occur on the 3rd-10th days after surgery. Due to this opening, the acidic liquid in the stomach and the food taken spills into the abdominal cavity and causes infection.

This infection, called peritonitis, is the most serious of the gastric sleeve surgery risks. If not treated well, it can lead to death of the patient. The risk of leakage after sleeve gastrectomy is reported to be 1%. Although staple line strengthening materials have been developed to minimize the development of leakage, there has been no significant reduction in the risk of leakage after their use. Likewise, tissue adhesives used to strengthen the staple line do not reduce this risk.  The way to minimize the leakage complication, which is one of the leading risks of sleeve gastrectomy surgery, is to strengthen this line with surgical sutures. The use of special suture materials developed for this purpose has minimized the risk of leakage after sleeve gastrectomy. If we take a look at the results of our clinic, thanks to the suturing technique we have developed in 2420 patients in the last 6 years, we have not encountered any leakage complication except for a micro leakage suspicion. This has made the “leakage” event, which is the most important of the risks of sleeve gastrectomy surgery, less than one in a thousand in our patients.

Embolism should also be mentioned among the risks of sleeve gastrectomy surgery. Embolism occurs when an abnormal blood clot forms in the veins in the legs during surgery and in the early days after the patient wakes up or after a period of 2 weeks to 3 months, the clot breaks away from the vessel wall and reaches vital organs such as the heart, lungs and brain and blocks the vessels there. Depending on the size of the clot and the location of the blocked vessel, serious health problems may occur and even life-threatening. In order to prevent embolism after sleeve gastrectomy surgery, Clexane blood thinner injection is administered to the patient the night before surgery. During the operation, embolism prevention stockings are worn on the patient's legs and blood circulation in the legs is maintained with the help of a device that applies intermittent air pressure. It is very important for the patient to walk in the early hours after surgery. Blood thinners are continued during hospitalization and for some time after discharge.

Bleeding after sleeve gastrectomy is another complication. Bleeding occurs at a rate of 3% after sleeve gastrectomy. Again, it occurs due to the opening of the vascular mouths on the gastric sleeve surgery staple line and the most effective way to prevent this complication is to apply sutures that fold this line inward.

Among the risks of sleeve gastrectomy surgery, it is necessary to mention the problem of persistent vomiting that may occur after surgery. Again, due to the lack of training of the surgeon performing the surgery, stenosis occurs due to the stomach tube that cannot be shaped properly. If the stenosis is serious, vomiting occurs even with liquids. This mechanical stenosis, which is the most serious cause of vomiting after sleeve gastrectomy, develops mostly in the middle part of the stomach tube. These strictures are tried to be opened with an application called balloon dilatation. If gastric sleeve balloon dilatation is not successful, gastric bypass surgery can be revised.

Vitamin deficiencies are also important among the risks of sleeve gastrectomy surgery. Vitamin deficiencies may occur as a result of the patient not being followed up by a nurse and dietician after surgery. Vitamin B12 deficiency is the most important of these and it progresses insidiously and can be overlooked unless it is checked. Iron and folic acid deficiency are other important vitamin deficiencies seen after surgery. In order to prevent vitamin and mineral deficiencies after sleeve gastrectomy surgery, close patient follow-up and intermittent tests are very important.

Among the risks of sleeve gastrectomy surgery, muscle loss and bone resorption should also be mentioned. Although not as serious as malabsorptive surgeries, bone resorption and muscle loss may also occur after sleeve gastrectomy surgery. Again, in order to prevent these complications, close follow-up and measurements of the patient after surgery are very important. Quality nutrition is almost indispensable after sleeve gastrectomy.