Can My Sleeve Pouch Stretch Back to Its Original Size?
As you probably know by now, the gastric sleeve is the only major bariatric procedure that actually removes a portion of the stomach entirely from the abdomen – about 80% in fact. There are several reasons for this. First, it makes for a relatively simple procedure in that no part of the small intestine is rerouted such as in the gastric bypass. Second, it offers a great deal of restriction without the need for a surgical implant like the gastric band. It also removes the fundus of the stomach which is the hunger hormone producing center of the body. Most patients receive the added benefit of feeling fewer hunger pangs.
However, many patients wonder if the new, smaller stomach can stretch back to its normal size. It’s a good question and requires us to tell the little deeper into the anatomy of the stomach.
The short answer is yes, the stomach can stretch and does so for very good reasons. When we eat a significant amount of food or, for example drink lots of fluid along with our food, or consume carbonated beverages, the stomach has to expand in order to accommodate the extra volume. If it didn’t, the result would alternately be serious gastroesophageal reflux or rapid gastric emptying into the small intestine (dumping syndrome), either of which would be very uncomfortable, to say the least. After the food or drink has been consumed, the stomach returns to its normal size.
How likely it is for the stomach to stretch permanently depends on the time frame as well as your general dietary habits. Occasional overeating after bariatric surgery is inevitable and, in general, nothing to be concerned about. It is usually self-limiting. In other words, you will feel very uncomfortable stretching their pouch after surgery and hopefully, this is enough to stop you from doing it regularly.
However, if you continue to overeat, day after day, week after week, month after month, the stretching can become permanent. Further, satiety signals can become confused and crossed leading to the need for more food at every meal.
How do you stop this from happening?
The hardest part about the post bariatric surgery diet is that we have to maintain it for the rest of our lives. Of course, there are times where we will indulge or splurge and have to work a little bit harder in the days afterwards to get back to baseline weight. But as we liberalize our lifestyles and diets – an inevitability over time – it becomes harder and harder to stay disciplined.
If we could offer two pieces of actionable advice it would be to a) drink water only an hour before and after your meal and to slow down. Avoiding drinking beforehand makes sure you get enough nutrients with your meal (you might get too full on liquid and not eat enough protein for example). Avoiding liquids during your meal prevents overfilling your stomach and stretching it without knowing. Remember that liquids pass into the stomach very quickly, but it can take upwards of 20 minutes for food to get there. Second, eating slowly will help your body understand when it has reached its limit. If you eat too quickly, we will overeat before your brain has the chance to realize that your stomach is full. The slower you eat, the more likely you will be to achieve appropriate satiety.