Complications of Sleeve Gastrectomy

Early Complications (≤30 Days)

The American Heart Association, American College of Cardiology, and The Obesity Society guidelines report that there is insufficient evidence to determine the incidence of perioperative and long-term complications of sleeve gastrectomy, but current data show that this procedure can lead to serious complications 1, 2, 3, 4, 5
The combination of fever (≥38°C), tachycardia (≥110 beats/min), and leukocytosis is a significant predictor of leakage 6, 7
Abdominal pain and absence of bowel sounds are significant predictors of leakage 6
If clinical signs of peritonitis are present, surgical exploration should be performed within 12-24 hours, as delay in imaging confirmation can increase mortality 6
Deep vein thrombosis and pulmonary embolism occur in 0.4% of laparoscopic cases, with risk factors including high BMI, limited mobility, and previous history of thromboembolism 8

All patients are at risk of dehydration and macro/micronutrient deficiencies, especially with inadequate oral intake or frequent regurgitation 8
Thiamine deficiency requires regular screening and prophylactic treatment, as Wernicke's encephalopathy has been reported 8
Patients with severe vomiting should be tested for potassium deficiency and treated before undergoing emergency endoscopy 8
Patients taking proton pump inhibitors should be evaluated for magnesium and calcium deficiency 8
Depression and anxiety scores are high, and medical teams often neglect psychological assessment 8, 7

High BMI is an independent predictor of complications 8
History of obstructive sleep apnea is an independent predictor of complications 8
Previous bariatric surgery history is strongly associated with adverse outcomes 8

A multidisciplinary approach with daily communication between the endoscopist, interventional radiologist, bariatric surgeon, dietitian, and primary care team is essential 8
Endoscopic approaches should be considered in hemodynamically stable patients, regardless of the time interval after surgery 8
Carbon dioxide insufflation is recommended 8
Laparoscopic exploration is the preferred initial approach in hemodynamically stable patients 6
Open laparotomy is recommended in cases of hemodynamic instability, severe peritonitis, or inability to perform laparoscopic repair 6

The 90-day mortality rate is very low, ranging from 0.1% to 0.3% in the general population 8
Patients over 65 years old are at significantly higher risk, with a 90-day mortality rate of 1.3% and a overall complication rate of 20.1% 8