Late Complications of Bleeding in the First 24 H After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study

Abstract

Background The objective of this study was to assess the long-term (>= 12 months) clinical outcomes of early postoperative bleeding (within 24 h) following laparoscopic sleeve gastrectomy (LSG). The focus was on late complications such as persistent vomiting, constipation, malnutrition, gastroesophageal reflux disease (GERD), gastric stenosis, muscle wasting, and sarcopenia. Methods A total of 463 patients who underwent LSG between 2019 and 2024 were retrospectively analyzed.Among them, 27 patients developed early postoperative bleeding, confirmed by clinical and radiologic evidence, and treated according to the Clavien-Dindo classification. All patients had at least 12 months of follow-up, during which complications were evaluated using standardized diagnostic definitions. Statistical comparisons were made between bleeding and non-bleeding groups. Results Patients with early bleeding had significantly higher rates of persistent vomiting (33.3% vs. 6.2%), constipation (40.7% vs. 14.2%), malnutrition (29.6% vs. 6.3%), and GERD (29.6% vs. 6.2%), gastric stenosis (14.8% vs. 1.3%), and sarcopenia (mean muscle wasting: 23.7% vs. 14.8%) (p < 0.001). Bleeding increased the risk of severe sarcopenia (> 20% muscle wasting) by 6.2-fold. Conclusion Bleeding within the first 24 h after LSG has a negative impact on long-term clinical outcomes, and regular follow-up and early intervention, nutritional support, and multidisciplinary follow-up strategies are critical for managing this patient group.