The fear of suffering a lot of pain after gastric sleeve surgery, is such a common concern that we’ve decided to delve a little on the subject.
The answer to this question is: No, there will not be extreme pain, it will be moderate and easily controlled with medications administered during the first hours after surgery.
Based on personal experience from our patients, pain intensity varies from one patient to another since the pain threshold is different for each one of us. Our patients are often surprised at how just a few hours after having undergone a major procedure they can feel so good. Some even, jokingly, ask if they really have been operated.
What are the causes of pain after gastric sleeve surgery?
There are different factors that determine the intensity of postoperative pain of gastric sleeve.
1. Patient's pain threshold
As mentioned previously, this varies from person to person.
2. Technique used by the bariatric surgeon
There are various ways and techniques around the world where there are instruments that require the use of larger incisions, some surgeons perform this procedure on a single incision, it is known as "single port laparoscopic surgery" or “SILS” which theoretically reduces pain as only one incision is used, however in our opinion this is not so true because since it is a single incision it must be of several centimeters and manipulation of the incision is exaggerated.
In any serious bariatric center, the gastric sleeve surgery is performed laparoscopically, the number of incisions can range from one up to 7 small incisions that can range from 2 millimeters to 12 millimeters each and the technique used for your surgery will vary depending on the preference of your bariatric surgeon.
3. Tolerance to drugs
There are cases where for some reason the patient is used to take strong painkillers (narcotics), or sedatives (benzodiazepines, etc.). If the patient has taken them for a long period of time there is a chance that he/she has developed some tolerance, so the usual dose for postoperative pain control will not be enough for them.
However this does not mean that pain cannot be controlled in these cases, but will require higher doses. Hence the importance that your surgeon gets to know in detail your particular case and that the patient provides him/her with information of the medications (or drugs) you take regularly.
4. Excessive manipulation during surgery
One of the reasons that we ask the patient to undergo a preoperative diet before gastric sleeve surgery, when the case warrants it, is to let the technique used in surgery become as “simple” as possible.
Achieving certain preoperative weight loss makes it easier for your surgeon and this will translate in much less manipulation of your internal organs, more specifically your liver, stomach and its surroundings, along with less need of manipulation of the incisions on the abdominal wall.
5. The lack of experience of the surgeon in this procedure
We dare to make the observation that if surgery is being offered via conventional approach, meaning open surgery with a large incision from the sternum to near the navel, consider to look for more options because the only reason to start a gastric sleeve with the conventional technique would be because of lack the surgeon’s experience with the laparoscopic technique, which is fully established and indeed this is how the gastric sleeve was "born", as a pure laparoscopic procedure.
How intense is the pain after gastric sleeve operation?
To put things in perspective, our patients have told us that the pain felt after gastric sleeve surgery, in comparison with other previous operations is much less than:
- A laparoscopic appendectomy
- A laparoscopic gallbladder surgery
- A cesarean section
If your surgery is performed by a team of experienced surgeons, you should expect a completely tolerable pain using painkillers for a period of only 24 to 36 hours. After this time, medication can usually be "as needed (PRN)” when the patient begins to feel discomfort.
In general terms the patient must feel abdominal discomfort from mild to moderate, mostly around the incisions and mainly in the one where the portion of resected stomach was taken out from the abdominal cavity. Many of our patients describe the discomfort they perceive as having made many abdominal crunches, which is a very acceptable and negligible pain considering the magnitude of the procedure.
Besides the discomfort of the abdominal wall incisions, one of the most common symptoms of almost all gastric sleeve patients is a "pressure" sensation that some patients perceive as pain in the upper abdomen and/or lower chest, this is due not to the incisions made in the skin and abdominal wall or even the stomach, but due to the drastic change in the stomach’s capacity that goes from approximately 50 oz to only 3 oz to 4 oz, so minimum amounts of air that we usually swallow and the saliva we produce are enough to make your body feel like it is a tremendous amount of stomach contents.
This happens in a timespan of only minutes therefore the body and brain of the patient require several hours to adapt to this new stomach size. The sensation is similar to when a carbonated beverage is gulped down very fast and develops abdominal pressure and an imminent need to release the gas, either through belching or passing said gas into the small intestine.
How I can prevent or decrease the abdominal pain after gastric sleeve surgery?
As for the pain in the incisions
Besides the observation regarding the need for compliance to preoperative diet, if requested by the surgeon, the truth is that it depends mostly on the experience of bariatric team including also the anesthesiologist’s experience in postoperative pain management.
In terms of pain or pressure in the upper abdomen and/or lower chest
In this case, patients have at their reach the ability to reduce this discomfort caused by gas (air into the stomach) through the simple act of walking. For this reason we encourage our patients to walk as soon as possible (without forcing them) during the first hours after surgery. The sooner you begin to move out of bed after surgery, the sooner you will feel relief from that abdominal pressure.
In summary, beyond the pain medication which obviously must be administered to the patient during the first hours, the best "medicine" for abdominal pressure is walking and time.
The passage of time is a key factor because during the first 24-48 hours after surgery the stomach has an important level of mucosal inflammation. A simple way to explain it is: when we've been hit in the lip and swells up, so does the stomach inside, this coupled with the new small size of it, we can understand why this sensation.
We explain to our patients if we could cut that stomach transversely and see it, there would not be a "lumen" or gastric cavity present, it is a virtual space at that time. But only within hours the swelling begins to decrease and within a few days (varies from one patient to another) the patient will notice that such discomfort disappears.
Frequently asked questions from our patients about pain after surgery
We would like to clarify two situations that often lead to confusion in some patients:
Pain caused by gas
Patients often have the notion that the pain previously described (air inside of the stomach) comes from the gas (carbon dioxide) which is introduced into the abdominal cavity to perform any laparoscopic procedure and this is not correct.
This gas is extracted almost entirely at the end of the procedure, we seek to take it out because if left inside in considerable amount, could be cause of shoulder pain during the first hours after surgery. However, this gas is not found in the stomach (the organ) but outside of it, in the abdominal cavity.
Another situation that occurs much less often is that some patients perceive pain from air in the stomach as hunger pangs, which is a very similar pain but has no relationship with the sensation of appetite.
After being discharged from the hospital
When the patients have been discharged from the hospital, at this point, discomfort level will depend on the patient, not only on the incisions but also internally, in the stomach. Our suggestion is to adhere completely to the directions given by your surgeon primarily regarding postoperative diet and physical activity to avoid doing something that could make you develop pain at home that can be avoided.
For more details on what to expect during the early stages of recovery after gastric sleeve surgery we invite you to visit our post related to the topic.
If you are considering gastric sleeve surgery and are doubtful of this decision out of fear of having pain, surely we can say that the pain should not be part of your fears, and much less the main reason for not deciding to get your surgery done. Consider that it is just a few hours of controllable discomfort in trade for a higher quality of life and health.
Your turn, please let us know if you still fear pain after having your gastric sleeve surgery, or if you have any another concerns related to the procedure.
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Written by: Gabriel Rosales
Dr. Gabriel Rosales is a highly skilled, board certified surgeon in constant pursuit of learning the latest innovations in the weight loss surgery field to give his patients the best care possible.