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Can You Stretch Your Stomach Pouch After a Gastric Sleeve or Bypass?

man holding his stomach with both hands

The gastric sleeve and gastric bypass comprise most of the bariatric surgeries performed in the United States and worldwide. There’s a good reason for this, as these two procedures safely and effectively address the obesity and excess weight concerns of most patients that qualify for bariatric surgery. Both procedures also cut away a significant portion of the stomach, leaving only a fraction of the original stomach volume (though the sleeve involves removing stomach tissue while the bypass does not). As such, there is concern from most patients, quite rightly, that they could stretch their gastric pouch at some point in the future.

If you’re asking whether it is possible to stretch your gastric pouch, the answer is yes. The answer is more nuanced if you’re asking whether it’s easy to do so. In short, stretching your gastric pouch requires consistently straying from your postoperative diet program for months, if not years.

Let’s Explore Why

The stomach is a very adaptable organ. If you overeat, which we all do, your stomach will stretch. However, just as it expands, it also contracts. Therefore, occasional indulgences will not lead to permanent stretching of the pouch. Like any other body part, the stomach will adapt to what it considers the new normal. Again, if you are eating and drinking through your postoperative diet, your body will eventually adjust to the new reality and stretch to accommodate what it knows is coming.

Mechanisms Are in Place to Prevent Stretching

Fortunately, bariatric surgery puts mechanisms in place to reduce the likelihood of stretching your pouch. The gastric sleeve, for example, cuts away about 75% of the original stomach pouch at what is called the greater curvature. By removing this portion of the stomach, we also remove the central production system of the hunger hormone known as ghrelin. With much of the ghrelin production gone, patients experience diminished hunger. In fact, in the first several months after surgery, patients often wonder how they can eat enough to follow their postoperative diet – they often don’t feel hungry at all. It is worth knowing that this hormonal benefit lasts for about two years at which point the small intestine begins to adapt and produce some ghrelin itself.

The gastric bypass also has a self-limiting mechanism. Because the stomach is so tiny and the valve between the stomach and small intestine is removed during surgery, eating too quickly, or eating very high-fat, or high-sugar foods can trigger a condition known as dumping syndrome, or rapid gastric emptying. This is akin to a sugar drop that, while very uncomfortable, is by no means life-threatening. However, dumping syndrome also gives patients a good idea of how much they can and should eat.

With these mechanisms in place, both gastric sleeve and gastric bypass patients have a good deal of time to adapt their diets and mindsets for the long term.

How to Reduce the Likelihood of Stretching Your Pouch

Avoid liquids during your meals. Liquids go down very quickly and, as a result, can overfill your stomach. And drinking during or shortly after a meal can make you hungrier sooner, as it pushes food into the small intestine more quickly. It can also take up valuable space that would otherwise be filled with nutritious foods, increasing the likelihood of a nutritional deficiency. As a result, patients should avoid drinking 45 minutes before or after a meal.

Avoid carbonation. The bubbles you consume from carbonated drinks can fill up the stomach and stretch the pouch significantly. Be mindful that after a gastric sleeve, your stomach pouch is already at a higher pressure, and adding more pressure, in the form of carbonation, can cause significant discomfort, stretching, and reflux.