My Gastric Sleeve Complications Story

Surgeon Response to "My Gastric Sleeve Complications Story"

by: John Rabkin, M.D., Pacific Laparoscopy

Dear "NI in Tuscaloosa, AL,"

Your post Verticle Sleeve Gastrectomy (VSG) recovery has certainly NOT been smooth! It is uncommon (but not unheard of) in my experience for patients to have this set of symptoms following the procedure.

First and foremost, although you didn't state explicitly that you are continuing under the care of and working closely with your bariatric surgeon/surgical team, I assume that to be the case. IF not, I'd strongly recommend that you contact them IMMEDIATELY. Often, if patients are not closely followed by their bariatric providers and attempt to have their care delivered by their local care providers, important issues may be overlooked and unnecessary difficulties may arise.

The next step in your urgent care would be to ensure that you are adequately hydrating: if you're unable to adequately hydrate, you won't be able to eat and/or continue your post operative recovery. Your use of a balanced electrolyte solution like Powerade as you've outlined is a good start. You may also benefit from a small amount of sugar to assist in feeling better so that you can break a cycle of illness and resultant dehydration prolonging your infirmity.

Your thought of lack of protein intake for the past three months also contributing to your symptoms is also on point: if you've become so malnourished over the three months since your procedure, you may even need parenteral nutrition (ie: 'food by vein') for a period of time to feel well enough to get 'back on tract' to nourish orally. This would initially need to be pursued in an inpatient environment requiring re-hospitalization. You may also by this time have some vitamin and mineral deficiencies contributing to your symptoms: these should be looked for and supplemented as appropriate.

Some patients have previously unrecognized/undiagnosed gastrointestinal motility disorders such as esophageal motility dysfunction and/or swallowing disorders that first become evident after the VSG. The 'high pressure' nature of the VSG along with potential worsened esophageal reflux may trigger these disorders to manifest themselves when previously (pre-operatively) quiescent.

This requires expert evaluation typically by neuro-gastroenterologists with expertise in these types of disorders. Swallowing evaluations, esophageal manometry, upper GI endoscopy as well as potentially other investigations all may be of value is assessing the root cause of your current symptoms. Once diagnosed, pharmacologic therapy (medications) can often help.

Even in the absence of a recognized gastrointestinal dysmotility disorder, medications may offer substantial benefits. These would include:

1. proton pump inhibitors (PPIs) such as Protonix or Carafate
2. anti-emetics such as Zofran or Compazine
3. agents to relax the esophagus if in spasm such as Nifedipine&amp
4. pro-motility agents like Reglan

All of these potential interventions should be considered in your case to evaluate their potential contribution to your overall recovery.

In my experience, the few patients I have cared for who have suffered post operative courses similar to that which you've described have all ultimately recovered and are pleased with their overall results of their Weight Loss Surgery (WLS.)

They are uniformly thankful (without regret) that they'd undergone WLS to address their underlying morbid obesity. Once they'd gotten past their initial post-operative difficulties, they've enjoyed the health benefits accrued from the dramatic beneficial weight loss from the WLS. Consequently, I'd recommend that you focus on addressing these issues you currently face with the promise and conviction that you will soon be free not only of these symptoms, but also from the obesity which has been troubling you for a far longer time!

John M. Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Pages:

• Gastric Sleeve Surgery - All You Need to Know
• Gastric Sleeve Diet - Pre-Op, Post-Op, & Long-Term