What to Expect After Gastric Sleeve

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The majority of individuals express satisfaction with the outcomes of gastric sleeve surgery even a decade or more post-procedure. However, around 20% may encounter enduring complications encompassing issues such as food tolerance, weight regain, and even challenges in relationships. These complications have the potential to persist for an extended period following the surgery.

This article aims to provide insights into what individuals can anticipate a decade after undergoing gastric sleeve surgery, also referred to as sleeve gastrectomy. Additionally, it delves into strategies for preventing complications and guides on when it is advisable to seek guidance from healthcare professionals.

Weight Regain After Gastric Sleeve

The outcomes a decade post-gastric sleeve surgery generally show positive results. Studies indicate that a significant majority can maintain an excess body mass loss ranging from 51% to 54% after 10 years. This signifies that individuals typically shed around half of their surplus weight and manage to sustain this weight loss over the course of a decade.

Weight regain subsequent to gastric sleeve surgery can be attributed to various factors. It may be linked to the size of the sleeve or other elements, such as an increase in the hormone signaling to the brain that the stomach is empty. Another contributing factor is the failure to adhere to the recommended diet and exercise plan prescribed by healthcare providers, which may lead to weight regain in the years following gastric sleeve surgery.

Pros and Cons of Gastric Sleeve Surgery

Gastric sleeve surgery offers several advantages:

  1. Effective Weight Loss: The procedure restricts food intake to approximately 1/2 cup at a time, leading to significant weight loss.
  2. Permanent Solution: Gastric sleeve surgery is a permanent surgical intervention.
  3. Weight Management: It proves beneficial for individuals who have struggled with weight loss and maintenance.
  4. Health Improvements: The surgery may contribute to enhanced long-term health, addressing issues like diabetes and high blood pressure.
  5. Enhanced Quality of Life: Studies indicate that various bariatric surgeries, including gastric sleeve, result in an improved quality of life marked by advancements in physical fitness, mobility, and pain relief. Gastric sleeve recipients often report greater improvements compared to those who undergo gastric band surgery.
  6. Low Risk of Mortality: Death resulting from gastric sleeve surgery is a rare occurrence.

However, there are drawbacks to consider. Despite the surgery, overeating remains a possibility, potentially hindering weight loss. The procedure may not always address long-term health conditions, and complications may arise. It’s essential to be aware of both the advantages and disadvantages when contemplating gastric sleeve surgery.

Gastric Sleeve Side Effects and Complications After Operation

Certain individuals may encounter complications and side effects after undergoing gastric sleeve surgery, with these issues manifesting within days to months post-surgery. While some of these complications and side effects may ameliorate during the recovery process, it is plausible for gastric sleeve surgery to give rise to persistent problems that endure for years following the procedure.


Some individuals who undergo gastric sleeve surgery may experience heightened instances of indigestion or upset stomach. This phenomenon could be attributed to the reduction in stomach size resulting from the surgical procedure. Alternatively, it might be associated with alterations in the digestive tract’s food transit process.


After undergoing surgery, certain individuals may experience diarrhea, which can be attributed to shifts in the gut’s bacterial balance post-surgery. Another factor contributing to this occurrence is the presence of undigested nutrients in the small intestine.

Persistent diarrhea has the potential to lead to dehydration or malnutrition. In cases where diarrhea persists, seeking assistance from a gastroenterologist, a medical professional specializing in digestive disorders, may prove beneficial.

Sagging Skin

When an individual gains excess weight, the skin undergoes stretching. Consequently, sagging skin becomes a common occurrence following any weight loss surgery, and this may become apparent within a few months post-procedure.

To address the issue of excess skin, a panniculectomy, a surgical procedure aimed at removing surplus skin, may be recommended. Typically, surgeons prefer to wait until the patient’s weight has stabilized for one to two years before considering or advising this particular surgical intervention.

Stomach Obstruction

Stenosis refers to the constriction or narrowing of the stomach outlet, leading to difficulties in the digestion of food. In some instances, it may even result in a partial blockage of the stomach. This complication typically manifests within six weeks following surgery.

To address stenosis, a surgeon has the option to rectify the issue by performing a procedure known as “stretching,” which aims to widen the narrow segment, restoring proper functionality to the digestive process.


Nausea stands out as a prevalent complication following gastric sleeve surgery. While many individuals observe an improvement in nausea during the recovery period, there are cases where it persists for several months or even longer.

The exact reasons behind the onset of nausea post-surgery remain somewhat unclear. One potential factor could be the prolonged retention of food in the stomach. In managing persistent nausea, medications designed to alleviate this symptom may prove beneficial.

Long-Term Gastric Sleeve Complications

Gastric sleeve surgery has the potential to give rise to mild to severe long-term complications, some of which may become evident within months or years following the surgical procedure.

If concerns arise regarding potential gastric sleeve complications that could manifest after a year or longer, it is advisable to engage in a discussion with your healthcare provider for personalized guidance and appropriate medical advice.

Food Intolerance

Following gastric sleeve surgery, individuals often find themselves unable to consume the same quantity of food in one sitting as they could before the procedure. This limitation can lead to difficulties in digesting specific foods, such as red meat, rice, pasta, and bread after surgery. The altered stomach capacity underscores the need for careful dietary adjustments to ensure effective digestion and nutritional well-being post-surgery.

Weight Regain

Weight regain commonly initiates around the third year post-surgery. Individuals who fail to modify their habits may experience a return of some or all of the weight they had previously lost. It underscores the importance of adopting and sustaining healthy lifestyle changes to optimize the long-term benefits of the surgical intervention.


Malnutrition, characterized by insufficient nutrition intake, is a significant concern that can manifest several years post-surgery. Certain patients may encounter difficulties in obtaining essential nutrients, particularly when consuming fewer calories, especially in the presence of complications like diarrhea or nausea.

To address potential nutritional deficiencies, healthcare providers may recommend a combination of vitamins, minerals, medications, or other interventions to support overall health and mitigate the risk of malnutrition in individuals who have undergone surgery. Regular follow-up consultations with healthcare professionals are crucial to ensure ongoing nutritional well-being.

Failure to Lose Weight

In the initial days following surgery, the stomach pouch is typically limited to holding only half a cup of food. However, as time progresses, the pouch tends to stretch. Weight loss may cease if larger meals are consumed, potentially occurring due to an enlarged stomach pouch or failure to adhere to post-surgery instructions.

Research findings suggest that approximately 20% to 35% of individuals encounter a long-term failure rate. This failure rate is defined by a body mass index exceeding 35 within 18 to 24 months following the surgical intervention. It underscores the importance of ongoing adherence to recommended dietary guidelines and lifestyle changes for sustained weight management success.

Gastroesophageal Reflux Disease (Acid Reflux)

Heartburn and various symptoms associated with gastroesophageal reflux disease (GERD) are frequent complications following gastric sleeve surgery, and they may become evident even a year after the procedure.

Symptoms encompass:

  • Bloating
  • Sensations of fullness
  • Upset stomach

To alleviate GERD symptoms, the use of acid-reducing medications can prove beneficial. Seeking guidance from healthcare providers is crucial for appropriate management and relief from these post-surgery complications.


Gallstones, which are solid formations that develop in the gallbladder, become more prevalent after undergoing any weight-loss surgery. Typically, these stones tend to manifest within 18 months following the surgical procedure.

As a consequence of the increased likelihood of gallstones, individuals may find themselves requiring a cholecystectomy. This surgical intervention involves the removal of the gallbladder to address issues arising from gallstone formation. It is important to be aware of this potential complication and consult with healthcare professionals for appropriate management if necessary.

Abdominal Adhesions (Scarring)

The tissues within the abdomen possess a slippery quality, facilitating smooth movement as they glide past each other during motion. However, in the days to years following surgery, the development of scarring may occur, leading to increased adhesiveness among tissues. This can result in a sensation of pulling, which may range from being merely bothersome to outright painful. In certain instances, this scarring has the potential to create obstructions in the small bowel, emphasizing the importance of monitoring and addressing such post-surgery developments through consultation with healthcare professionals.

Rare Gastric Sleeve Complications

Uncommon complications associated with gastric sleeve surgery can emerge anywhere from weeks to years after the procedure.


An abscess, defined as a pocket-like accumulation of pus within the body, may occur shortly after surgery due to intestinal contents leakage. An exceedingly rare complication is the development of an abscess in the spleen, the blood-filtering organ.

Delayed Leak

A delayed leak, also known as a suture line leak or disruption, involves the escape of stomach contents through the sewn area. While such leaks typically occur shortly after surgery, there are instances where they may manifest months or even years later. Though rare, delayed leaks pose a significant threat, potentially necessitating medications, hospitalization, or additional surgical intervention.

Symptoms of gastric sleeve leakage include:

  • Fever
  • Abdominal pain
  • Peritonitis (inflammation of the abdominal lining)
  • Hypotension (low blood pressure)
  • Leukocytosis (elevated white blood cell count)
  • Tachycardia (increased heart rate)

Individuals experiencing an elevated heart rate or other concerning symptoms should promptly contact their healthcare provider for assessment and appropriate guidance.

Preventing Gastric Sleeve Complications

Preventing complications before and after gastric sleeve surgery involves careful consideration of various factors.

Before Surgery

  1. Preoperative Evaluation: Undergo a thorough preoperative evaluation to assess your overall health and identify any pre-existing conditions that might impact the surgery.
  2. Education: Gain a comprehensive understanding of the surgical procedure, potential risks, and postoperative expectations through thorough education provided by healthcare professionals.
  3. Lifestyle Changes: Begin making necessary lifestyle changes, including adopting a healthy diet and incorporating regular exercise, to enhance your overall well-being and prepare for the surgery.
  4. Mental Health Support: Seek mental health support if needed, as the emotional aspects of weight loss surgery are crucial for long-term success.

After Surgery

  1. Follow Postoperative Instructions: Adhere strictly to the postoperative guidelines provided by your healthcare team, including dietary recommendations, activity restrictions, and medication instructions.
  2. Regular Follow-ups: Attend regular follow-up appointments with your healthcare provider to monitor your progress, address any concerns, and ensure proper healing.
  3. Nutritional Support: Incorporate nutritional supplements as recommended by your healthcare team to prevent malnutrition and support optimal recovery.
  4. Hydration: Maintain adequate hydration, as dehydration can contribute to complications. Consume the recommended amount of fluids daily.
  5. Gradual Return to Activity: Gradually reintroduce physical activity following surgery as per your healthcare provider’s guidance to avoid strain on the surgical site.
  6. Monitor for Complications: Be vigilant for any signs of complications such as infection, unusual pain, or changes in symptoms, and promptly report them to your healthcare provider.

By being proactive and diligent in both the pre- and postoperative phases, individuals can contribute significantly to minimizing the risk of complications associated with gastric sleeve surgery.

When to See a Healthcare Provider

After surgery, your healthcare provider will schedule follow-up appointments to assess your progress and recovery. However, it’s crucial to promptly reach out to your healthcare provider if:

  • Signs of Infection: If you notice signs of infection at the surgical site, such as increased redness, swelling, warmth, or discharge, contact your healthcare provider immediately.
  • Unusual Pain: Persistent or worsening pain that is not alleviated by prescribed medications should be reported promptly to your healthcare provider.
  • Changes in Symptoms: If you experience unexpected changes in symptoms, such as new or severe abdominal pain, digestive issues, or other concerns, seek medical attention.
  • Fever: The development of a fever may indicate an underlying issue, and you should contact your healthcare provider if your temperature rises.
  • Difficulty Breathing: Any difficulty breathing or chest pain should be addressed urgently, as it could indicate respiratory or cardiovascular issues.
  • Unexplained Weight Changes: Significant and unexplained fluctuations in weight, whether rapid gain or loss, should be discussed with your healthcare provider.
  • Dehydration: Signs of dehydration, such as extreme thirst, dark urine, or dizziness, warrant immediate attention.
  • Medication Issues: If you experience adverse reactions to prescribed medications or have concerns about your medication regimen, consult your healthcare provider promptly.

By being proactive and seeking prompt medical attention when needed, you contribute to your own well-being and ensure that any potential complications are addressed in a timely manner.


  1. Coblijn UK, Karres J, de Raaff CAL, et al. Predicting postoperative complications after bariatric surgery: the bariatric surgery index for complications, BASICSurg Endosc. 2017;31(11):4438-4445. doi:10.1007/s00464-017-5494-0
  2. Alhuzaim WM, Alajlan RM, Alshehri RA, et al. Post-gastric sleeve surgery chronic symptoms from a sample of patients in Saudi communityCureus. 2023;15(7). doi: 10.7759/cureus.42000
  3. Kraljević M, Cordasco V, Schneider R, et al. Long-term effects of laparoscopic sleeve gastrectomy: What are the results beyond 10 years? Obes Surg. 2021;31(8):3427-3433. doi:10.1007/s11695-021-05437-3
  4. Lauti M, Kularatna M, Hill AG, MacCormick AD. Weight regain following sleeve gastrectomy-a systematic reviewObes Surg. 2016;26(6):1326-34. doi:10.1007/s11695-016-2152-x
  5. Askari A, Arhi C, Mamidanna R. Quality of life following bariatric and metabolic surgery. In: Patient Reported Outcomes and Quality of Life in Surgery. Cham: Springer International Publishing; 2023:85-96. doi:10.1007/978-3-031-27597-5_7
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