Sleeve Gastrectomy Complications: Persistent Belching and Heartburn

Many patients who undergo sleeve gastrectomy (a type of bariatric surgery) report experiencing post-operative complications, especially persistent belching and heartburn. These issues can significantly impact quality of life. This article will explore these complications, their prevalence, and the potential causes and solutions.

Understanding Sleeve Gastrectomy and its Risks

Sleeve gastrectomy is a surgical procedure designed to help individuals struggling with severe obesity. By removing a significant portion of the stomach, it reduces the amount of food that can be consumed, leading to weight loss. During the procedure, part of the stomach is transformed into a smaller tube-like shape, typically leaving the patient with about 15% of their original stomach capacity.

While sleeve gastrectomy is generally a safe procedure, it is not without risks. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the risks associated with the surgery include excessive bleeding, infection, anesthesia reactions, blood clots, lung or breathing problems, and leaks from the cut edge of the stomach. These short-term risks are concerning but are relatively manageable for skilled surgeons.

Long-Term Complications and Their Impact

The long-term complications of sleeve gastrectomy include gastrointestinal obstruction, hernias, gastroesophageal reflux, low blood sugar (hypoglycemia), malnutrition, and vomiting. Among these, gastroesophageal reflux disease (GERD) is a common concern. GERD is a long-term condition where stomach acid moves back into the esophagus, causing heartburn, a painful burning sensation in the chest or throat. Patients with GERD may experience symptoms more than twice a week, leading to a diagnosis of chronic GERD.

Connection Between Sleeve Gastrectomy and GERD

Many patients who have undergone sleeve gastrectomy report experiencing heartburn episodes, especially those who had existing GERD or a hiatal hernia prior to surgery. A hiatal hernia is when part of the stomach extends up into the chest through the opening in the diaphragm. The removal of a portion of the stomach during sleeve gastrectomy may increase the likelihood of GERD returning, as the gastroesophageal junction is altered, and the ability to contain stomach acid is reduced. In some cases, the esophagogastric junction can narrow postoperatively, leading to strictures or stenosis, which can exacerbate GERD symptoms.

Diagnosing and Treating GERD Post-Sleeve Gastrectomy

Diagnosing GERD after sleeve gastrectomy involves a combination of clinical evaluation and diagnostic procedures such as endoscopy. An endoscopy can help identify stenosis (narrowing) in the upper portion of the gastric sleeve and the reappearance of a hiatal hernia, both of which can contribute to persistent heartburn. Treatment options for GERD following sleeve gastrectomy include medications (such as proton pump inhibitors and H2 blockers), lifestyle modifications, and, in severe cases, invasive procedures like esophageal dilation or fundoplication.

Conclusion: Addressing Post-Operative Symptoms

Patients who have undergone sleeve gastrectomy and are experiencing persistent belching and heartburn should not hesitate to consult their healthcare provider. A thorough evaluation and proper treatment can significantly improve their symptoms and overall quality of life. Awareness of the potential complications and the steps to address them can empower patients to seek the best possible care.