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Will I Stretch My Gastric Sleeve Pouch?

Man on couch holding stomach

If you are considering the gastric sleeve or have already had one, you may be concerned about whether you can stretch the newly created pouch after your bariatric procedure. You may have even heard of other patients who enjoyed excellent weight loss results only to regain some or all their weight after years or decades, and you may be concerned that you will end up in that same position. First, we should say that you’re asking the right question. You’re concerned about the long-term integrity of your surgery, and this, while boring compared to the excitement of rapid weight loss, is the key to your long-term success and health. Even before we continue, it’s worth mentioning that success is up to you, and whether your sleeve stretches or not is based on your willingness to follow a new, and sometimes rather challenging, postoperative lifestyle.

About the Gastric Sleeve and Why It Could Stretch

The gastric sleeve is a straightforward procedure. During surgery, we remove approximately 75 to 85% of the stomach vertically. This leaves a banana or a sleeve-shaped pouch behind. The cutaway portion of the stomach is removed from the abdomen. The sleeve works by mechanically limiting the amount of food a patient can eat and removing the primary production center of a hormone called ghrelin. With this, you will feel far less hungry and won’t experience the cravings a purely restrictive procedure would allow for. You can still overeat, however, which is typically why you stretch your pouch. Early on, eating anything more than a little food will be very hard. It will be painful. However, your diet will liberalize over time, and the stomach pouch will eventually allow for more food intake. This is normal and necessary because you still need appropriate nutritional consumption to stay healthy. However, this is also when you can overdo it.

Now, it’s essential to say that an occasional lapse in judgment or a large meal will not permanently stretch your pouch. Yes, it will likely be very uncomfortable, and your pouch will have stretched, but after the food passes through the stomach, it will shrink back to its previous size. Patients who have permanently stretched their pouch usually do so by overeating consistently day after day and week after week. Eventually, the stomach recognizes that the new normal is larger. It’s a very adaptable organ and will figure out ways to distend.

How Can I Avoid Stretching My Pouch?

This may sound flippant, but ultimately, following your postoperative instructions closely is the best way to avoid stretching your pouch. You can get creative within the guidelines, and we always love to hear about patients who learn how to cook or enhance their cooking skills to create phenomenal meals without overindulging. However, limiting what you eat and the speed at which you eat it and exercising regularly has always been the key to long-term bariatric success. Before surgery, we try to stress this to ensure our patients are primed for a successful postoperative life.

What Happens if I Stretch My Pouch Permanently?

Fortunately, very few people stretch their pouch to the size that it once was. Frankly, it’s almost impossible and would require dedication to that end. So, patients will always have some restrictions. If you are diligent about following your numbers and notice that you are beginning to put on some excess weight, the first step is to contact our office so that we can go over your meal plans to understand if something can be improved. This usually works well to get you back on track. From there, we can consider weight loss medications to stabilize any weight gain. While it’s not always necessary, it’s an excellent tool in our back pockets. Only as a last resort will we consider a revisional or conversion procedure, which, in the case of a gastric sleeve, will require converting the original surgery to a gastric bypass or duodenal switch. Insurance often covers these conversion procedures, but preapproval is granted on a case-by-case basis and is not guaranteed.

Next Steps

Patients must understand they have control in their postoperative life. If you are starting to gain weight, don’t shut down and hide out, thinking that you have failed. Every bariatric patient has experienced setbacks in the process. Further, don’t be afraid to speak to us. We are not here to judge your abilities or motivations; instead, we want to see you succeed because your achievements are also our wins. You have a wealth of knowledge and support to tap into between our office, your support group peers, your family and friends, and other support sources. Don’t wait until you’ve become frustrated and depressed about weight gain. Instead, muster up the courage to ask for help because, after all, we can’t do this alone. We encourage you to contact our office with any questions in your postoperative life. We are here for you and look forward to helping with your challenges and celebrating successes together.