Calling Dr Alvarez - a question for you good sir about sleeve stretching.

[Grace]

Dr Alvarez -
There is much debate on whether a sleeved stomach can stretch out over time.
Do you have any wisdom to impart on whether this can happen, and if so, how much?
A few oz? Back to pre-surgery size?
Does the sleeved stomach stretch less than the rny pouch or about the same?

Thank you very much for your knowledge and your time. My surgeon has only been doing sleeves for about 2 yrs and would not have your experience with what can happen longer term.

Grace

[Grace]

I did find this information which states the average new sleeve is 3.65 oz and the average sleeve 2 yrs out is 8.45 oz.
Wondering if that seems accurate? If so, I'm going to postulate that regain/slowdown is not from volume as much as it would be from food choices, as 8 oz still doesn't sound like a whole lot of food....

Evaluation of the radiological gastric capacity an... [Obes Surg. 2009] - PubMed - NCBI

[katemom]

My friend is an eating behavior specialist who works with pre- and post-WLS patients. She told me that when she's working with patients who are regaining it's usually caused by them increasing carbs in their diets over time.

[scgal21]

At 8 months out, I can eat well over 8 oz at a time. I choose not to and continue measuring my food, but my stomach could possibly hold as much as 12-16 oz. I wonder if our stomachs have a genetic component, elasticity, age, etc. that's individual like our skin?

[Hosack]

My Dr said everyones stomach will get bigger. Thats why we shoul'nt eat more than we should and really use the extreme weight loss of the first year to kickstart our exercising and change of life. Thats what I was told

[5DogMa]

Hum, interesting. I think it will eventually stretch out some, but if you abuse it by constantly over filling it, it could double in size or more over a long period of time. At 9 months out I still can only eat maybe 3/4 of a cup at one time depending on what it is. The more dense the food the less I can eat. So meat maybe at the most 1/2 cup with nothing else. Salad which doesn't agree with my sleeve anyway it maybe 1 cup. Then I regret it afterwards. I really believe what katemom said about you start to increase your carbs later which will cause you to gain weight. I just wish the nausea everytime I eat or drink would go away. I always feel sick after eating and drinking especially in the mornings. Well, not really it's all the time the nausea. I worry that I could stretch it out and eat as much as I use to. I hope not and I'm sure not going to try to stretch it out.

[Dr_Alvarez]

Hello Grace and members of Gastricsleeve.com!
Thank you for the call. It'll be my pleasure to help out. Sleeve stretching is known with time. The sleeve will never ever stretch out to the original size though. But the larger the original sleeve (larger bougie used in surgery) and if funds of the stomach is left behind you will have a tendency to stretch out your sleeve. Nowadays most surgeons use bougies between 32-36 which reduces this risk. The surgical technique is important to make sure the sleeve is done correctly and removing the part of the stomach called funds (which also reduces the Ghrelin hormone).
Now, patients with sleeves will notice that the restriction is amazing at the first few weeks at that is mainly due to the swollen tissue of the stomach because of the recent surgery. It is not your real capacity. As the swollen tissues comes down your stomach will have more "space" to hold food but still a fraction of what you used to eat prior to surgery.
The etiology of the bypass patient who regains weight is or stretches the pouch is quite different since RNY patients have an anastomosis that will distend with time along with the small intestine that will enlarge in diameter giving more capacity to the patient. Since the sleeve lacks all these issues you just need to focus on healthy food and make the most of the weight loss specially the first 12 to 18 months. I hope this makes sense?

Glad to help out here on the forum. I will post a FAQ video on this question soon and more to come this week on my Youtube channel
Dr. Alvarez's Channel | Subscribe here »»» - YouTube

Have a wonderful weekend.
Dr. Alvarez

[Grace]

Thank you very much Dr Alvarez. I knew we could count on you to educate us
I shall ask my Dr if she removed the fundus. I already know she used a 36 bougie but that's so relative with stomach length and all. My capacity at a year out is 3 oz of meat, 6 oz of soup and 1 1/2 cups of soft lettuce; so I guess I'm doing ok.
Again, thank you for your help and looking forward to your video as always.
Grace

[bookwrmmom]

Wow that was so nice of Dr. Alvarez!! I have not yet asked the size of bougie that was used for my surgery, but will do so at my 2 mth follow-up appointment.

[jerzeygirl]

I would like to thank Dr. Alvarez for taking time to answer Grace's question. I would also like to thank Grace for her proactive question and directing it to someone who has the professional experience to answer this frequently asked question. I'm going to share this with my local support group, as this is a FAQ among them.

[Dee Leshuz]

The sleeve will never ever stretch out to the original size though. But the larger the original sleeve (larger bougie used in surgery) and if funds of the stomach is left behind you will have a tendency to stretch out your sleeve.

Thank you! My own research (and my HMO) confirms this.

ETA

I also think it's useful to give a visual like, your stomach before was the size of a football, now it's the size (and shape) of a banana, but it will never stretch to its original size.

[leesooim]

Our surgeon gave us a packet with an illustration of the digestive system that showed via dotted lines and a small gap what part of the stomach is taken out, leaving the final image of the sleeve by itself, which to me basically resembled an extension of my esophagus lol.

I have no idea what bougie they used -- I didn't ask, but I DO have a copy of the operative report for my records, so maybe it's in there. I also didn't ask about the fundus either -- didn't know about it at the time. Going into surgery I didn't research the particulars of HOW it's done on the web because quite frankly, I don't trust internet resources and things can vary from doctor to doctor. I would hate if I were a surgeon for instance for a patient to come in and tell me how they want me to perform their surgery, but perhaps that's just me.

Thank you for the information, Dr. Alvarez!

[chelles15966]

So it will never stretch out to normal size?

[patch640]

Very good information passing to everyone out there. Thanks so much.

[Dee Leshuz]

So it will never stretch out to normal size?

No. It will expand over time normally, but we're talking ounces, and never to the size it was originally.

ETA

Of course, you can get into trouble w/ no expansion at all, eat sliders, grazes, drink liquid calories, etc.