Will my stomach pouch stretch after surgery?

It is normal to have temporary stretching of the stomach after consuming a large meal which shrinks back down during the digestive process. However, what we often see in obesity is not a temporary stretching of the stomach but a permanent one. A permanently large, dilated stomach inhibits the feeling of fullness allowing for a larger quantity of food intake and a higher caloric intake which ultimately leads to weight gain.

This is where bariatric surgery comes into play, most notably the sleeve gastrectomy procedure. The Sleeve Gastrectomy operation reduces the stomach’s overall capacity to achieve much earlier satiety.

In a Sleeve Gastrectomy the stomach is reduced to about 20% of its original size, allowing for a smaller amount of food needed to achieve a sense of fullness which helps with decreasing excessive food intake, decreased calories consumed and therefore leads to weight loss.

According to the Bariatric Journal (3/2019 edition), the stomach lining (mucosa) has folds known as “rugae.” The “rugae” allow the stomach to expand to accommodate more food. With digestion and emptying of the stomach content into the small intestine, the stomach gradually returns back to pre-meal size. However in obese individuals, the imbalance between the fullness hormone (satiety) and appetite hormones results in excess food intake and permanent stretching/dilation of the stomach resulting in obesity.

It is very important to listen to your body’s signal of fullness to prevent constant overeating and avoid re-stretching the stomach permanently. Routine dietary indiscretions will ultimately result in inadequate weight loss and weight regain. Permanent stretching of the stomach is COMPLETELY PREVENTABLE with strict adherence to dietary and exercise plans. Smaller amounts of food at a sitting (6-8oz max), not drinking with meals and waiting 30 minutes after, and avoiding carbonated beverages will help avoid stomach dilation.

If permanent stretching of the stomach does occur over time that has interfered with weight loss or you’re now struggling with weight regain, there are interventions available. The pouch re-set is the most common first line non-surgical intervention. Surgical options sometimes need to be considered such as a re-sleeve or a conversion to the gastric bypass or loop duodenal switch. Behavioral modifications and adherence will need to be addressed before a revisional surgery would be considered.