Gastric Sleeve Leak Symptoms

Written by Kristen Carli, RD and medically reviewed by Dr. Stephen Boyce, MD

All medical procedures involve some type of risk. Although gastric sleeve surgery is well-researched and safe for most individuals, as with any surgery, there is still a chance of complications. 

One possible complication of the gastric sleeve surgery is the gastric sleeve leak. This complication is rare, however, it is life-threatening. 

A gastric sleeve leak occurs when digestive fluids from the stomach leak out into the body through a hole or seam in the new stomach pouch. Gastric leaks can cause significant harm to the body and even death. Digestive fluids contain acids and other substances that break down food. If these fluids are not contained in the digestive system, they can then cause injury to other organs, muscles, and tissues in the body.

Even though this complication is rare, it is still important to be aware of the symptoms caused by a gastric sleeve leak. It is unlikely that your gastric sleeve surgery will result in this complication, but if you notice any of the following symptoms, seek emergency medical attention immediately.

When do leaks occur?

Gastric sleeve leaks are due to an unintended perforation in the new stomach pouch, so in most cases, gastric sleeve leaks occur within 3-14 days of surgery. In a study of 2,834 patients, only 3 patients experienced a leak after 14 days. If you had your surgery less than one month ago and experience any of these symptoms, you may have a gastric sleeve leak. 

The most common gastric sleeve leak symptoms include:

  • 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˚
  • Dizziness
  • Feeling of anxiety or illness
Gastric Sleeve Leak Symptoms

In addition to the above-mentioned physical symptoms, your surgeon and medical team will consider the following lab values to diagnose a gastric sleeve leak:

  • White blood cell count
  • C-reactive protein (CRP)

Although gastric sleeve leaks are uncommon, there is always a chance of this complication. You should always assess yourself for signs and symptoms of gastric sleeve leak and continue regular follow-up visits with your surgeon. 

Symptoms may vary based on when the leak occurs. Patients who experience a gastric sleeve leak shortly after surgery often present with increased heart rate, while patients who don’t experience a leak until later often have a mild or high fever.

There are some instances in which a patient may have a gastric sleeve leak but exhibit none of the physical symptoms. That is why it’s important to continue scheduled follow-ups with your surgeon. Physicians can diagnose a gastric sleeve leak in asymptomatic patients with x-rays, blood tests, and gastric sleeve tests.

Immediate treatment of a gastric sleeve leak is imperative to preventing significant damage or death. In a matter of days, your condition can worsen considerably if not treated promptly. Watch for signs and symptoms of gastric leak particularly in the early days and weeks following your surgery. Report any abnormal physical symptoms to your surgeon immediately. 

Delayed gastric sleeve symptoms

Gastric sleeve surgery is a somewhat uncomplicated bariatric surgery that produces a high rate of successful outcomes, however, some patients may develop a delayed leak after surgery. Leaks that occur soon after surgery are easier to manage, but leaks that occur later usually require complex medical management. Here are some things you should know about delayed gastric sleeve leaks:

  • Multiple comorbidities increase the risk of delayed leaks.
  • Prolonged nutritional deficiency from poor diet quality may contribute to delayed leaks.
  • Delayed leaks usually occur with chronic fistulas and peri-sleeve abscesses.
  • Treatment of delayed gastric leave will vary based on the size and location of the hole. Endoscopic surgery techniques are often used. 
  • More invasive surgery may be needed for a patient who develops a gastric sleeve leak after more than 1 year. 
  • Treatment for a delayed gastric sleeve leak should involve a multidisciplinary approach including a surgeon, radiologist, and dietitian.
Delayed Gastric Sleeve Symptoms

Additional warning signs

Although you may experience pain if you develop a gastric sleeve leak, there are also other signs you should be cognizant of:

  • Dizziness
  • Fever
  • Shortness of breath
  • Fast heart rate
warning signs of a gastric sleeve leak

Can gastric sleeve leaks occur after 1 year?

Gastric sleeve leaks are rare in general, but developing a leak after 1 year is even more uncommon. This delayed leak is treated as a serious complication and requires complicated gastric sleeve leak treatment. Early leaks can be treated with less invasive techniques, however, delayed gastric sleeve leaks that occur after 1 year are unlikely to heal with these conservative methods.

Occurrence of gastric sleeve leak long-term after surgery

One study showed that a patient exhibited gastric sleeve leak symptoms, including fever, chills, and fluid buildup 10 months after the gastric sleeve surgery.  The surgeon performed an endoscopic gastric sleeve leak test to diagnose the leak. Several minimally invasive methods were used to try to manage the leak. After these unsuccessful attempts, a more aggressive gastrectomy was needed to treat the condition.

It is highly unlikely that a gastric leak will occur 2 years or more post-surgery, although in some extremely rare cases it can happen. Leaks occurring 2 years or more after gastric sleeve surgery can cause severe complications. This is more likely to occur in a patient with multiple obesity-related co-morbidities. A surgeon may need to perform laparotomy to drain the fluid and repair the leak.

When the stomach is fully healed after gastric sleeve surgery, which usually occurs at about 1 year, the risk of gastric sleeve leak is almost nonexistent. However it can occur if there is a separation at the staple line wound, a bacterial infection, or an oxygen insufficiency in the tissue around the staple line. Late leaks are considered a major complication and require urgent gastric sleeve leak repair, considering the significant risk of death associated with this complication.

Gastric sleeve leak test

If you experience gastric sleeve leak symptoms, such as abdominal pain, shoulder pain, fast heart rate, dizziness, report them to your surgeon. To confirm the presence of a gastric sleeve leak, they will likely perform a physical exam, blood work, and a gastric sleeve leak test. The test may include an upper GI tract x-ray or a CT scan.

A contrast dye liquid will be used to help create clear diagnostic images. You will be asked to drink this before the procedure. If the x-ray or CT scan shows that the colored dye is leaking through the gastric tube, it will confirm the diagnosis of a gastric sleeve leak. 

Gastric Sleeve Leak Tests

Treatment for gastric sleeve leak

If you are diagnosed with a gastric sleeve leak, emergency surgery will be required. Your surgeon will determine the location of the leak and repair it, as well as assess surrounding areas for damage. If the volume of the leak is significant and the damage is severe, a further operation may be necessary to repair any damage caused by leaked stomach fluids.

Qualified surgeons will always follow up with post-operative patients to closely monitor their healing and recovery. They will perform thorough exams and test for any leaks or other complications. Gastric sleeve leaks are incredibly rare, but they can still happen. So it’s imperative that you know the signs and symptoms to watch out for. 

If you have any signs or symptoms of a gastric sleeve leak, contact your surgeon immediately or seek emergency medical care. 

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