Gastric Sleeve Common Problems

Image of consultant bariatric surgeon, Mr Rishi Singhal

Medically reviewed by Prof Rishi Singhal MBBS, MRCS, FRCS, MD

What are the common problems with a Gastric Sleeve?

The common problems associated with a gastric sleeve include wind pain, abdominal discomfort, nausea, constipation, fatigue, flatulence, hair loss, and reflux/indigestion/heartburn. These issues can be addressed with various strategies and medications, and close monitoring of symptoms is recommended.

Getting used to your gastric sleeve surgery can be very daunting and you might be quite worried about any new sensations or feelings you are experiencing. We’ve listed some common symptoms and problems below.

Wind pain after a Gastric Sleeve

Wind pain is most felt in phases 1 to 2 when you’re recovering from your surgery. Quite typically it is felt in your left shoulder and maybe even your neck. It is very common after any laparoscopic surgery due to the gas used to lift your abdominal wall away from your organs.

If wind pain / trapped gas is experienced after this time it is normally due to a poor eating technique. Wind remedies are the most effective treatment: Wind-eze, Deflatine, gripe water or peppermint tea.

Placing a hot water bottle over the shoulder may also relieve the pain. If you feel you need to, you can also take liquid analgesia such as effervescent paracetamol.

Abdominal discomfort after a Gastric Sleeve

In phases 1 and 2, you may be aware of aches and pains in your chest wall and abdomen especially when you are moving about and taking fewer painkillers. These are referred to as musculoskeletal pains and are a normal part of the keyhole cuts healing inside. Scar tissue will be forming, and this is a bit less flexible than your tissues were before.

If the pain is associated with eating or drinking, it is likely to be due to a poor technique. This discomfort is often felt as pain under breastbone.

It is important to reduce the frequency of this discomfort as much as possible by following the 20,20,20,20 technique:

  1. Take a 20-pence-sized bite of food.

  2. Chew for 20 seconds. Even though there might not be much to chew in this phase, it is important you still wait this length of time before moving to the next step.

  3. Once swallowed, wait at least 20 seconds before you prepare your next bite.

  4. Repeat the above steps over a period of 20 minutes. Stop before this if you feel you have had enough.

Nausea after a Gastric Sleeve

Nausea, or feeling sick, is a very common feeling in phase 1. It can be associated with drinking a lot of milky drinks or meal replacement shakes. Swapping to soups may be better but it’s important to fortify these with protein e.g., skimmed milk powder (if this doesn’t cause nausea) or unflavoured whey protein powder. If you are really struggling with nausea, please let us know so we can help.

Some people might experience diarrhoea in the first few weeks after surgery. A lot of changes have occurred to your digestive system, your diet and perhaps your medications which could be contributing to this. Make sure you drink plenty of fluids to replace what you are losing and have a bland, low fat diet. If the diarrhoea is particularly troublesome, get your GP to check that you do not have overflow diarrhoea or an infection. You can also talk to our medical team who might suggest some changes to your diet.

Constipation after a Gastric Sleeve

You might be constipated if you haven’t had a poo at least 3 times during the last week; the poo is large and dry, hard or lumpy; or you are straining or in pain when you have a poo. This is much more common than diarrhoea following surgery because you are now taking much smaller quantities and there is very little fibre in a liquid and soft diet.

If you suspect that you are constipated, there are 3 things to check

  1. Make sure you are drinking at least 2 litres of fluid per day.

  2. Include 1-2 cups of diluted vegetable juice per day.

  3. Make sure that you are active and not sitting or lying around too much!

If it is still a problem, you may require a laxative. There are a few different types: bulkforming, osmotic, stimulant and poo-softener. Avoid any bulk-forming (e.g., Fybogel) or stimulant (e.g., Dulcolax, Senna) laxatives too soon after surgery.

Try osmotic or poosoftener laxatives which help make the stool softer and easier to pass, for example, CosmoCol, Docusol, lactulose, Laxido or Movicol. Please call us if you are unsure on how to manage constipation.

Feeling tired, lack of energy

For the first 2 weeks after your surgery, you are likely to feel tired. We do encourage you to walk daily to help reduce the risk of developing a DVT, but don’t overdo things. Even when your wounds look healed on the outside, they are still healing inside. The further into your weight loss journey you go, having a lack of energy could be a sign of a nutritional deficiency.

Make sure you’re drinking and eating regularly, taking all your supplements and have regular blood tests. Please refer to our information sheet on vitamin and mineral supplements – it can be found on our website

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Flatulence after a gastric sleeve

Following gastric sleeve surgery, it can be common to experience more flatulence, “wind”, than you would have done before. It can be due to undigested food reaching the intestine quicker and fermenting which causes gas, or due to eating or drinking too quickly. If it’s a problem for you, try limiting foods that are common causes of excess wind such as brassicas (e.g., broccoli, Brussels sprouts, cabbage and kale) and beans.

Following surgery, you may notice you get a dry or a ‘furry’ mouth. This is quite common after general anaesthetic. Make sure you drink plenty of fluids and breathe through your nose more. It may be useful to use a mouthwash and make sure you brush your teeth well twice a day. You can also try sucking ice cubes, low calorie ice lollies or sugar free mints.

Hair loss after a gastric sleeve

Losing hair after weight loss surgery can be very distressing. It is fairly common and usually due to losing weight quickly and your body prioritising your reduced intake on other bodily functions rather than producing hair.

You should start to notice regrowth after several months, but you need to make sure you are meeting your protein requirements, taking the recommended supplements and having the recommended regular blood tests. 

Reflux / indigestion / heartburn

If you are experiencing any of these soon after surgery, please ensure you take the correct medication you were prescribed to help reduce the acid production in your stomach. This is often 30mg lansoprazole to be taken once a day for 3 months. If you are a smoker, it is advised to take life-long. 

Often reflux/indigestion/heartburn symptoms are the result of eating a high fat, spicy or acidic food. Try avoiding these foods for a week or so. If there is no improvement, it may be due to an infection caused by helicobacter pylori (bacteria). Please contact us if you are finding it difficult to manage your symptoms. 

Image of consultant bariatric surgeon, Mr Rishi Singhal

All content on this page is reviewed by a multi-disciplinary team lead by Prof Rishi Singhal.

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