Can I Stretch My Gastric Pouch After a Sleeve?

The gastric sleeve is the most commonly performed bariatric surgery in the United States and represents one of the most popular surgeries worldwide. The benefit of the gastric sleeve revolves around its simplicity; approximately 80-85% of the stomach is cut away and removed from the abdomen. This provides restriction, limiting how much food a patient can eat. In addition, however, the sleeve has a hormonal component that reduces hunger in most patients. Because the fundus of the stomach is removed, the main production center of ghrelin, the hunger hormone, is also eliminated. The result is that patients may lose 60%, 70%, or even more of their excess body weight and maintain that weight loss for a significant amount of time – potentially for the rest of their lives.

Of course, it is easy to think that this new, smaller gastric pouch will always remain the same size. However, the stomach is a very adaptable organ and does stretch to accommodate extra food when we overeat (regardless of whether you’ve had bariatric surgery). This stretching usually is not a problem, and the stomach eventually returns to its previous size after the digested food has moved into the small intestine. However, constant overeating can lead to longer-term and even permanent stretching, ultimately reducing the procedure’s effectiveness by allowing the patient to eat more food at each meal.

So, the basic answer to the question as to whether a patient can stretch their pouch is yes; with consistent noncompliance and poor post-operative habits, it is possible to stretch your gastric patch.

Preventing the Stretch

Patients who have had bariatric surgery for the first time are sometimes unaware of the challenge of losing weight and maintaining that weight loss over the long term. Many mistakenly believe that bariatric surgery is the out, but it most certainly is not. The best way to prevent a stretch pouch is to follow the instructions provided by your bariatric practice, including avoiding carbonated beverages, eating within the guidelines provided by your practice, and ensuring you stay well hydrated while exercising regularly. All the keys to good overall health are also central to success after any bariatric surgery, including the gastric sleeve.

It’s also important to note that the ghrelin, as mentioned above, reduction in the body is limited to the first 2 to 3 years after surgery. Eventually, the small intestine will start to make up for it, and hunger will eventually return slowly. As such, it’s critical to reinforce good habits over the first couple of years after surgery.

Managing Weight Gain After a Gastric Sleeve

While most patients are very successful in their postoperative lifestyle change, mainly because we have guided them to understand their responsibilities, some begin to regain their weight later in their postop bariatric life. Some weight gain is expected, as most patients will liberalize their diet over time. A few pounds of weight regain is typically nothing to be concerned about and represents a longer-term new normal that is likely significantly lower than starting weight. However, weight gain becomes concerning when it is more significant or if there are substantial fluctuations regularly. This means that something may be wrong, and intervention is necessary.

First, we work closely with any patient gaining weight to analyze their diet and exercise habits to see if we can find a gap causing the weight to regain. Most of the time, this is a very fruitful exercise, and patients can identify and ultimately reduce and reset to get back on track. Remember, some mindless snacking over the day, whether due to boredom, stress, or other emotions, can add up and cause significant caloric overconsumption.

In some cases, patients will stretch their gastric pouch to the point where maintaining their weight loss is no longer possible, and they begin to gain weight rapidly again. This can be exacerbated by the shame and embarrassment of “failure,” leading them to not return to their surgeon’s office for follow-ups.

These patients may be suitable for what is known as revisional bariatric surgery. This is a secondary procedure meant to correct the dilation of the stomach pouch and get patients back on track with their weight loss. The secondary procedures must be performed at a highly qualified practice with lots of revision experience. These surgeries come with greater risk due to scar tissue and other possible complicating factors of the initial surgery. Dr. Jacobs is an expert in revising bariatric procedures that have failed due to a patient’s weight regain. Fortunately, most patients have already gone through the initial bariatric process. Therefore, revisions tend to be highly successful.

Markers of Success

With thousands of bariatric surgeries performed, Dr. Jacobs and our team know the markers of success in their patients. We work closely with you in the pre-operative period to ensure you are a candidate for surgery from a physical perspective and help you understand your role and responsibilities in your success. Ultimately, patients must fully commit to the bariatric process and lifelong change. However, for patients worried about a life where food is no longer enjoyable, this is not the case. Bariatric patients, especially those who undergo the gastric sleeve, can enjoy most foods in moderation (The big no-nos are added sugars, excessive alcohol, and a few others). We encourage our patients by telling them their eating will be normal, albeit somewhat reduced.

Most importantly, patients must engage with their bariatric practice before and after surgery to ensure they are on the right track. Keep up with your follow-up appointments, go to your support groups, and get advice from your practice and online. Fortunately, all the trials and tribulations of bariatric surgery have been experienced and overcome. It just requires finding the proper support to stay on track.

For more information, we encourage you to contact our office and schedule a visit to discuss regain or the potential for a revisional bariatric procedure.