Any surgery comes with a measure of risk, and even though gastric sleeve surgery is quite safe, there are still some complications associated with the procedure.
One potentially life-threatening but rare complication is called gastric sleeve leak, and this occurs when digestive fluids from the stomach leak out through a hole or seam in the new stomach pouch and into the rest of the body.
Leaks can be fatal because digestive fluids contain substances that are meant to break down food. Once escaped, these fluids can then cause a great deal of damage to other organs, muscles, and tissues in the body.
As such, it’s imperative to be aware of the possibility of this complication following surgery, and be able to notice the indicators of gastric sleeve leak so you can seek medical attention immediately in the unlikely event that you encounter this problem.
Leaks tend to appear shortly after surgery
Because leaks involve a hole in the seam of the new stomach pouch, this complication typically arises within two to four weeks of the procedure and rarely occurs more than six weeks post-surgery. Therefore, if your gastric sleeve surgery was less than a month ago and you are experiencing the symptoms discussed here today, then it’s possible that you may have a leak.
Gastric sleeve leak symptoms: What does a gastric sleeve leak feel like?
A vast majority of VSG leaks are diagnosed within the first week after the surgery. These are called early leaks. In exceptional cases, the signs of gastric sleeve leak may appear later. These are clinically known as delayed leaks. All patients with this complication will require urgent gastric sleeve leak treatment. Here are some of the common gastric sleeve leak symptoms that should alert the patient and the healthcare provider to this condition:
- Persistent abdominal pain that may continue to worsen
- Shoulder pain and/or chest pain
- Rapid heart rate (tachycardia) of at least 120 beats per minute
- Tachypnea or respiratory distress with at least 19 breaths per minute
- Fever in excess of 98.6˚
- Feeling of anxiety or illness
The medical team will also consider the following two clinical symptoms along with the physical gastric sleeve leak symptoms:
- An increased blood count of leucocytes (white blood cells)
- An increased level of C-reactive protein (CRP) in the blood
VSG leaks are rare, but their occurrence cannot be ruled out. You should remain vigilant and maintain your follow-up visits to the surgeon’s office.
Variable symptoms: It is noteworthy that the signs of a leak after gastric sleeve can vary depending on the when the leak occurred. For instance, patients with an early leak may reveal an increased heart rate, while delayed leak after gastric sleeve symptoms usually include mild or high fever.
Asymptomatic patients: In some cases, the patient may not develop any external or obvious symptoms, and may remain asymptomatic. In these cases, the doctors can diagnose a VSG leak with periodic monitoring of the patient using a gastric sleeve leak test, x-ray imaging, and blood tests.
Timely treatment: Even a small gap of one or two days can make a crucial difference to your gastric sleeve leak repair and treatment. Therefore, it’s critical to remain alert to any abnormal signs, especially in the early days and weeks after the surgery, and report any concerns to the surgeon.
Delayed leak after gastric sleeve symptoms
Although vertical sleeve gastrectomy (VSG) is a relatively simple bariatric surgery with a high success rate, some patients may develop early or delayed leak after gastric sleeve symptoms. Early leaks are relatively easy to manage, but delayed leaks usually require complex medical management. Here are some of the key facts related to delayed leak after gastric sleeve:
- Multiple co-morbidities are a high risk factor for late leaks.
- Long-term nutritional deficiency may contribute to late leaks.
- Delayed gastric sleeve leak symptoms are more likely to be noticed around the proximal third of the sleeve.
- Late presentation of VSG leaks usually occurs in the form of chronic fistulas and peri-sleeve abscesses.
- Endoscopic techniques to treat the delayed signs of gastric sleeve leak can vary according to the size and location of the perforation.
- Aggressive surgery may be required for a patient who presents with a gastric sleeve after 1 year, 2 years or more.
- A multidisciplinary approach to treat a delayed leak after gastric sleeve should involve a surgeon, radiologist, intensivist, and nutritionist.
Other warning signs to watch for
Pain isn’t the only symptom of gastric sleeve leak; there are other signs you should keep an eye out for as well, including:
- Shortness of breath
- Fast heart rate
Gastric sleeve leak after 1 year
Gastric sleeve leak after 1 year is a rare occurrence, and may only happen in one out thousands of patients. This late leak is considered a serious complication, and will involve complex gastric sleeve leak treatment. While early leaks are often treated using conservative treatment modalities, late gastric sleeve leak after 1 year is unlikely to heal with conservative approaches.
A research study has shown that a patient developed gastric sleeve leak symptoms, including fever, chills, and fluid buildup within 10 months after the VSG surgery. An endoscopy gastric sleeve leak test was conducted to diagnose the leak. After multiple conservative management attempts, the doctors had to perform an aggressive gastrectomy to treat the condition.
Gastric sleeve leak after 2 years
A gastric sleeve leak after 2 years is a highly severe complication, which can pose a significant risk to the patient’s life. Fortunately, these types of late leaks are an extremely rare occurrence. The signs of gastric sleeve leak after 2 years are more likely to develop in a patient with multiple obesity-related co-morbidities. A laparotomy may have to be performed in the abdominal cavity to drain the fluid and stop the leak.
A research study showed that a 65-year old patient developed gastric sleeve leak symptoms 2 years after VSG. He suddenly experienced pain and soreness in the lower abdominal area, followed by fever and pain in the left shoulder. The patient had type 2 diabetes, hypertension, COPD, and other co-morbidities. Doctors had to perform seven laparotomies and other medical management techniques over four months to treat the condition.
Gastric sleeve leak after 4 years
Is it possible to have a gastric sleeve leak after 4 years? Yes, clinically it is possible, but the chances of this occurrence are very rare. In the initial days, weeks or months, some patients may develop signs of a leak after gastric sleeve as the swelling subsides. Based on this, gastric sleeve leakage after 4 years is unlikely for most patients because the healing process would be completed in less than one year.
When the stomach has fully healed, the risk of a staple line leak is virtually eliminated. Moreover, dehiscence (separation) of the staple line wound, a bacterial infection, or an oxygen deficiency in the tissue around the staple line may contribute to a delayed leak after gastric sleeve even at 4 years. Late leaks should be seen as a major complication requiring urgent gastric sleeve leak repair, considering the high morbidity associated with it.
Gastric sleeve leak test
Your bariatric surgeon may suspect an anastomotic leak if you complain of gastric sleeve leak symptoms, such as abdominal pain, shoulder pain, fast heart rate, dizziness, and anxiety. To confirm the diagnosis, they may perform a physical exam, blood work, and a gastric sleeve leak test. The test may include a serious upper GI tract x-ray or a CT scan.
Before the test, you will be asked to drink a contrast dye liquid, which will help create clear diagnostic images. If the results of the gastric sleeve leak test show that the colored dye is leaking through the gastric tube, it will confirm the diagnosis. In rare cases, the imaging tests may fail to reveal any signs of gastric sleeve leak. In this situation, an emergency lapartomy may be performed to look for a leak.
Treatment for gastric sleeve leak
When a gastric sleeve leak does happen, emergency surgery is required. During the operation, your surgeon will locate and seal the hole, and then inspect surrounding tissue and organs for damage. Depending on the severity and volume of the leak, additional work may be required to repair damage caused by the digestive fluids.
Skilled and qualified surgeons will monitor post-op patients closely in the days following surgery, and perform several inspections to look for leaks and other complications. Even though this complication is rare, it is still possible; therefore it’s crucial to know the signs and symptoms so you can keep yourself safe and healthy.
If you experience any of the symptoms talked about here today, contact your medical professional right away to discuss options.