From the Guidelines
Severe bloating and water retention two years after gastric sleeve surgery can be caused by protein malnutrition or protein-energy malnutrition, which can present several years following bariatric surgery, as noted in the British Obesity and Metabolic Surgery Society guidelines 1.
Causes of Bloating and Water Retention
- Poor dietary protein intake
- Malabsorption
- Difficulty progressing diet due to stricture, over-tight band, or food intolerances
- Protein malabsorption Other potential causes of bloating and water retention after gastric sleeve surgery include:
- Dumping syndrome, which can occur in up to 40% of patients after Roux-en-Y gastric bypass or sleeve gastrectomy 1
- Small intestinal bacterial overgrowth (SIBO)
- Constipation, which is common after bariatric surgery
- Iron deficiency anemia, which can occur after bariatric procedures that disrupt normal duodenal iron absorption 1
Management of Bloating and Water Retention
To address these symptoms, try:
- Keeping a food diary to identify trigger foods
- Staying well-hydrated while limiting sodium intake
- Eating smaller meals more slowly
- Considering taking probiotics to support gut health If symptoms persist, consult with your bariatric surgeon or gastroenterologist, as you may need specific testing for conditions like SIBO or nutritional deficiencies, or medication adjustments to alleviate these uncomfortable symptoms. It is also important to note that internal hernia, adhesive disease, jejuno-jejunostomy stenosis or kinking, incisional hernia, intussusception, and bezoar are potential causes of small bowel obstruction after gastric sleeve surgery, and early explorative laparoscopy is mandatory to avoid late diagnosis, intestinal vascular compromise, and bowel resection 1.
From the Research
Possible Causes of Severe Bloating and Water Retention
- Dehydration is a common complication after bariatric surgery, including gastric sleeve surgery, and can lead to severe bloating and water retention 2
- Gastric inflammatory conditions, such as chronic gastritis, are common in patients undergoing sleeve gastrectomy, but are unlikely to cause staple-line leaks or haemorrhages 3
- Complications after sleeve gastrectomy, such as staple line leaks or hemorrhages, can occur and may be preceded by large increments in intraabdominal pressure 4
- Functional and surgical complications, such as dumping, hypoglycemia, reflux, and acute or chronic abdominal pain, can occur after bariatric surgery, including gastric sleeve surgery 5
- Gastric leakage is a challenging complication of sleeve gastrectomy and can be managed using multimodal approaches, including drainage, clipping, and stenting of the leak, as well as percutaneous transesophageal gastro-tubing (PTEG) 6
Risk Factors for Dehydration
- Younger age (less than 40 years)
- Female sex
- Black race
- Longer length of stay during index admission (≥3 days)
- Postoperative complications
- History of gastroesophageal reflux disease, hypertension, or previous deep vein thrombosis
- Use of chronic steroid/immunosuppression therapy 2
Management of Complications
- Close surveillance and proactive measures may prevent the development of postoperative dehydration 2
- Rapid management of acute abdominal pain is essential and should be done in a specialized setting where appropriate imaging and specific surgical skills are readily available 5
- Multimodal approaches, including drainage, clipping, and stenting of the leak, as well as PTEG, can be used to manage gastric leakage after sleeve gastrectomy 6