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 removes a portion of the stomach entirely from the abdomen – about 80%. There are several reasons for this. First, it makes for a relatively straightforward procedure in that no part of the small intestine is rerouted, such as in the gastric bypass. Second, it offers excellent restriction without needing a surgical implant like the gastric band. It also removes the fundus of the stomach, the hunger hormone-producing center of the body. Most patients receive the added benefit of feeling fewer hunger pangs for a couple of years after surgery. Essentially the sleeve provides effective mechanical and hormonal mechanisms for weight loss.
Does the Stomach Stretch?
However, many patients wonder if the new, smaller stomach can stretch back to its original size. It’s a good question and requires us to tell a little deeper into the anatomy of the abdomen.
The short answer is yes; the stomach is one of the most adaptable organs. It can stretch, known as receptive relaxation) and does so for good reason. When we eat a significant amount of food, drink lots of fluid along with our food, or consume carbonated beverages, the stomach must expand to accommodate the extra volume. If it didn’t, the result could be severe gastroesophageal reflux or rapid gastric emptying into the small intestine (dumping syndrome), which would be very uncomfortable. Either way, you’d probably feel a good amount of pain along with it. After eating and drinking, the stomach returns to its normal size.
Can My Stomach Stretch Permanently?
The question here is what is normal and what is not. Immediately after surgery, your stomach pouch will be relatively tight due to the swelling from surgery and the staples placed along the dividing line of the stomach. Over time, that pressure will begin to relent, and you will undoubtedly be able to eat more than you could immediately after surgery. Eventually, the pouch will continue to accept a greater volume of food, which is normal. After all, it is important that you get proper nutrition through food, as much as possible.
How likely it is for the stomach to stretch permanently and abnormally depends on the time frame and your general dietary habits. Occasional overeating after bariatric surgery is inevitable and, generally, nothing to be concerned about. It is usually self-limiting. In other words, you will feel very uncomfortable stretching your pouch after surgery, and hopefully, this is enough to stop you from doing it regularly. During your recovery, you will also develop mindfulness tactics that can help you limit your eating and, by extension, reduce the likelihood of long-term pouch stretching.
However, the stretching can become permanent if you continue to overeat day after day and week after week. Further, satiety signals can become confused and crossed, leading to the need for more food at every meal.
This is somewhat complicated because the hormonal benefit of the gastric sleeve in the form of ghrelin suppression seems to be temporary. Sometime around the two-year mark, the intestine may begin to compensate for the removed fundus and begin producing its own ghrelin. This means that patients may start to feel hunger pangs once again. This is a crucial time by which you should have developed lifestyle habits that can overcome this.
How Do You Stop This From Happening?
The hardest part about the post-bariatric surgery diet is that we must maintain it for the rest of our lives. Of course, there are times when we will indulge or splurge and must work a little bit harder in the days afterward 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 a few pieces of actionable advice, it would be to:
- Stay hydrated throughout the day. A concept known as head hunger can lead you to overeat when you are dehydrated. Be sure to sip your water throughout the day and guess at least 64 ounces daily. Avoid drinking too much at once as this does not provide consistent hydration throughout the day
- Don’t drink water within an hour before and after your meal. Avoiding drinking beforehand ensures you get enough nutrients with your meal (you might get too full-on liquid and not eat enough protein, for example). Avoiding beverages during your meal prevents overfilling your stomach and stretching it without knowing. Remember that liquids pass into the stomach very quickly, but the food takes longer to get there.
- Slow down. Eating slowly will help your body understand when it has reached its limit. If you eat too quickly, you will overeat before your brain has the chance to realize that your stomach is full. The slower you eat, the more likely you will achieve appropriate satiety.
- This is one case where we suggest you don’t listen to your mother. Don’t eat everything on your plate if you have reached suitable fullness. Be sure to have consumed your proper nutritional intake and leave anything that’s left over. If you are at a restaurant, don’t hesitate to ask for a to-go box before starting the meal.
Of course, there are times when the gastric sleeve has stretched, and there’s not much you can do to change that. At this point, you should visit your bariatric surgeon or contact a revisional bariatric surgery specialist like those at MASJax to dive deeper into the causes of your weight regain. After a thorough valuation, your surgeon can offer advice on reversing the weight gain or, if necessary, begin considering a conversion/revision surgery.