Complications of sleeve gastrectomy

Complications of sleeve gastrectomy​ are often evaluated by imaging. For details about the surgical procedure, please see the parental article on sleeve gastrectomy.

Postoperative complications can be classified by etiology or temporality.

Early complications

• staple line leakage
  • clinical presentation: epigastric pain, fever, leukocytosis, +/- referred left shoulder pain due to phrenic nerve irritation
  • usually occurs within the first week postoperatively due to dehiscence of the staples, near the gastro-esophageal junction
  • CT findings include extravasation of orally administrated contrast media, extraluminal air foci and perigastric collection or abscess formation
  • fluoroscopy is the modality of choice for diagnosis of post sleeve leakage
• hemorrhage/hematoma: high-density perigastric collection, if it is large it can be drained under image guidance
• splenic injury
  • splenic infarction (most common)
  • laceration and subcapsular hematoma (less common)
• ​portovenous thrombosis
  • occurs due to dehydration
  • can affect portal vein or one of its branches, splenic, or superior mesenteric vein

Late complications

• gastric dilatation
  • patient regain weight with dilatation of the sleeved stomach
  • fluoroscopy and CT with oral contrast may show increased dilatation of the stomach, greater than expected post-operatively
• gallstones: rapid loss of weight results in gallstone formation (usually multiple and small)
• hiatal hernia
  • due to interruption of the normal fixation mechanism of the stomach
  • usually presents with symptoms of GERD
  • easily diagnosed by fluoroscopy and CT
• intrathoracic sleeve migration (ITSM)
• gastric stricture
  • can occur early (secondary to edema or ischemia) or late (secondary to fibrosis)
  • usually affecting the distal gastric pouch
• gastro-esophageal reflux disease: can arise de novo or exacerbate existing disease