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Can Your Stomach Stretch After Gastric Sleeve?

Posted on 28 Nov, 2021
Can Your Stomach Stretch After Gastric Sleeve?

Bariatric surgery is a lifeline for severely obese patients who feel they have tried and tested every diet and exercise regime on the market. The invasive operation will effectively limit the number of calories you can consume comfortably, helping you maintain a healthy, nutrient-rich diet and reduce the risk of weight-related health issues. 

Weight gain generally occurs as the result of the stomach stretching over time to accommodate for larger amounts of food.  And while gastric sleeve surgery is extremely effective as it condenses the size of your stomach, it is understandable as to why many patients are concerned about stomach stretching after surgery. 

Gastric sleeve surgery (or laparoscopic sleeve gastrectomy) involves the permanent reduction of your stomach by approximately two thirds. Medical instruments are inserted through a keyhole incision to excise a large portion of the stomach, leaving behind a small pouch or a ‘sleeve’. Keyhole surgery reduces scarring, post-surgical recovery time and potential complications. 

Undergoing gastric sleeve surgery is a permanent solution for weight loss. The smaller pouch leaves less room for food, limiting your overall food intake and greatly assisting with a caloric deficit. However, the true benefit of gastric sleeve surgery is the removal of the gastric fundus, the stomach area where grehlin, the hunger hormone, is created. Lower ghrelin levels make people feel less hungry and less inclined to over-indulge, ideal for weight loss.

As the leading Central Coast gastric sleeve clinic, we’re here to provide guidance around what you can expect with the operation. This article will provide all the answers to your question “can your stomach stretch after gastric sleeve?”, and give an in-depth review of the recommended diet practices after gastric sleeve surgery to minimise weight regain and the potential for stomach stretching.

Can Your Stomach Stretch After Gastric Sleeve?

Technically, the stomach can stretch after gastric sleeve surgery. However, it all comes down to sticking to a healthy, balanced lifestyle post-surgery.

For the most part, it’s likely for patients to increase their food intake and portion sizes over time.

Can your stomach stretch after gastric sleeve

So, can you stretch your stomach after bariatric surgery?

The short answer is yes. In fact, it’s normal. The stomach pouch will naturally stretch over time as the body adapts to the new needs of the digestive system. Your stomach will also expand with food consumption to accommodate the extra volume. However, you don’t want your stomach to over-stretch at every meal.

While normal stomachs can stretch to more significant amounts of food intake in one sitting, a stomach after a gastric sleeve is less capable. Permanent stomach stretching may occur due to poor eating habits sustained over more extended periods, requiring several months, if not years, to occur. Frequent overeating can lead to stretching, stall weight loss or even promote weight gain.  Your stomach cannot hold and digest nearly as much food as it could before surgery, so it is essential to implement certain eating behaviours and lifestyle changes to aid in your recovery and prevent possible bariatric complications. Following surgery, your bariatric surgeon will recommend eating regular, small, portioned meals to keep you satiated and reduce the chance of stomach over-expansion. 

Significant weight gain can occur as a result of suppressing hunger signals. Therefore, the key is to listen to your natural hunger and fullness cues to prevent excessive stomach stretching.

What Does Stretching Your Stomach Do?

A ‘normal’ stomach is built to adapt to food consumption. However, a gastric sleeve stomach pouch is incapable of stretching to accommodate larger quantities of food. Following surgery, if you overeat, you will likely feel nauseous and experience vomiting, making it difficult to gain weight.

Stomach stretching can render your gastric sleeve operation ineffective for weight loss.

Contrary to popular thought, the size of your pouch is not the direct cause of weight gain after bariatric surgery. Weight gain occurs due to a caloric surplus, which is more calories in than you burn. A smaller pouch only acts as a weight loss aid, encouraging patients to eat less naturally, roughly ¾ of a metric cup in one sitting. So, while a stretched poach is not the direct cause of weight gain, it can confuse your hunger cues and ability to feel full and satisfied after an adequately portioned meal.

What happens if stomach stretches after gastric sleeve

Sustained and frequent overeating can lead to significant stomach stretching over time and confuse your hunger and fullness signals. When your sleeve is extended, you’re essentially leading your stomach to believe it needs more and more food to feel full. You might experience hunger cues when you are still half-full rather than when your stomach is empty and you need nourishment. As a result, you may gain the weight back, even after gastric sleeve surgery. Patients must understand what eating behaviours and lifestyle changes they can adopt to minimise the potential for stomach stretching and weight regain.

How to Prevent Stomach Stretching After Gastric Sleeve Surgery

Gastric sleeve surgery reduces the space in your newly constructed stomach pouch to approximately a third of its original capacity. As a result, after surgery, patients will likely have to adjust their eating behaviours.

1. Eat Smaller Portions

To ensure you don’t overstress and stretch your stomach post-surgery, eat a small portioned meal every 3 to 4 hours, as your bariatric doctor prescribes. Choose protein-dense, balanced meals, chew slowly, thoroughly, and mindfully and end a meal feeling full and satisfied. Patients can also incorporate small snacks throughout the day to keep satisfied and prevent the temptation to overeat later. Regardless, to maintain a steady decrease in weight, stick within your recommended calorie intake every day.

2. Drink Fluids Before or After Meals

Fluid intake while you eat a meal can dilute your stomach acid and disturb your digestion and lead to vomiting. With limited space in your stomach following gastric sleeve surgery, compromising your digestion can result in stomach stretching. Aim to reduce your fluid intake at meals; only drink water, tea, or juices 20 to 30 minutes before your meal to allow your stomach to process the input and promote a healthy, functioning digestive system. Strive to eliminate carbonated and sugary beverages from your diet altogether.

3. Avoid Skipping Meals

Patients who have undergone gastric sleeves are often inclined to skip meals as a healthy aid in reaching their weight loss goals. However, in reality, the opposite is true. Skipping meals can lead to limited caloric intake and metabolic adaptation; it compromises the nutrients vital to your health and recovery after bariatric surgery. Further, skipping meals can send your body into starvation mode, leading to overeating later. Aim to stick to a structured diet plan and always have healthy, protein-rich snacks on hand to maximise your weight loss results and avoid stomach stretching.

4. Avoid Overeating and Binge Eating

Binge eating and overeating can result in inconsistent hunger signals, increasing the likelihood of falling into an overeating or binge-restrict cycle that can contribute to stomach stretching amongst other associated risks: acid reflux, abdominal pain and dumping syndrome. Occasionally overeating is unlikely to have any long-term repercussions, so enjoying a larger meal on a special occasion or holiday shouldn’t be a concern. However, frequent overeating can be highly harmful following gastric sleeve surgery. Some habits to implement in your day-to-day are measuring your food portions, following your diet recommendations and consulting your bariatric medical practitioner if you seek further advice.   

Patients who overeat to cope with heightened or lowered emotions, stress or boredom should seek other coping mechanisms or seek professional help.

To reduce overeating, try implementing the following healthy habits:

  • Reduce stress
  • Remove temptation
  • Eat regular, portioned meals
  • Eat nutrient-dense, fibre-filled, and protein-rich foods
  • Eat slowly and mindfully
  • Avoid being too restrictive; allow yourself a small treat weekly

If you struggle to maintain your overeating behaviours, contact your bariatric surgeon or another trusted medical practitioner.

How to prevent stomach stretching

What Do I Do If I have Stretched My Gastric Sleeve?

We’ve answered the question “can your stomach stretch after gastric sleeve?”, but is there still hope if your pouch has already been stretched?

The correlation between weight gain and stomach stretching is not well defined. However, if you have not met your weight loss requirements, noticed substantial weight gain, and are experiencing frequent hunger signals, regardless of whether you just ate or not, the volume of your sleeve might have stretched and increased. If you feel you’ve stretched your stomach, consult your bariatric surgeon immediately. They can offer you the resources you require to get back on track. Alternatively, they might recommend revision surgery.

There are four options for gastric sleeve revisions:

  • A Duodenal Switch
  • A Gastric Bypass
  • A Re-sleeve
  • A Lap-Band

Revision surgery is a last resort. A decent surgeon will work closely with bariatric practitioners, nurses, psychologists, dietitians, and exercise physiologists to help you lose weight first.

How Do I Choose the Right Surgeon?

If our breakdown of the question, “can your stomach stretch after gastric sleeve?”, has incited you to consider talking to the experts, look no further than Central Coast Surgery.

If you are considering weight loss surgery or are concerned that your stomach has stretched after a gastric sleeve procedure, get in touch with the leading weight loss surgery clinic, servicing patients in Sydney, Newcastle, and the Central Coast of NSW. Dr Ken Wong and the expert weight loss team at Central Coast Surgery are dedicated to providing the best surgical procedures and postoperative care treatment plans for their patients. We will discuss the various options available to you and determine the best course of action specific to your situation. For more information or to book a consultation, give the gastric sleeve Newcastle experts at Central Coast Weight Loss Surgery a call on (02) 4323 7000 today

Gastric Sleeve Side Effects

Posted on 25 Oct, 2021
Gastric Sleeve Side Effects

If you’re considering gastric sleeve surgery, then you’re probably also wondering about the possible side effects after gastric sleeve surgery.

Dr Ken Wong is a skilled surgeon who has performed thousands of successful weight loss surgeries and has a passionate team of specialist staff at Central Coast Surgery to support you along your weight loss journey.

Although gastric sleeve surgery is relatively safe, as with all medical procedures, there are some possible side effects of stomach sleeve surgery. This article will discuss the risks and rewards of undergoing this procedure and everything you need to know about the side effects of stomach sleeve surgery.

How Gastric Sleeve Surgery Works

Gastric sleeve surgery is a weight loss procedure that permanently reduces the size of your stomach by two thirds. The surgery is performed via a keyhole incision and is also known as a laparoscopic sleeve gastrectomy. The surgeon inserts instruments through the small incision in your abdomen to remove a large portion of the stomach, leaving behind a small stomach pouch or ‘sleeve’. The advantage of keyhole surgery is that there is reduced scarring and post-surgical recovery needed.

After the partial removal of your stomach, the remainder is closed with staples. Undergoing this procedure is permanent and will limit the amount of food you can eat as your stomach is smaller, and you will feel full quicker. Not only will eating less help you lose weight, but by removing most of the stomach, there is a significant reduction in the Grehlin hormone, which is responsible for stimulating hunger. You will therefore feel more satiated between meals.

Risks and Rewards of the Procedure

Morbid obesity can negatively affect a person’s physical and mental health leading to overall lower quality of life. Although there are risks associated with gastric sleeve surgery, the risks of living with morbid obesity are greater as patients with this condition are at high risk of developing life-threatening health conditions such as high blood pressure, diabetes, arthritis, sleep apnoea, high cholesterol, and heart disease. People with a BMI over 35 are also at an increased risk of developing depression, anxiety and experiencing lower social acceptance and isolation.

Gastric Sleeve Side Effects: After Surgery

The first week after surgery is typically the most critical time to monitor for possible complications, some of which could be minor and some more concerning. Potential side effects might include:

 1. Bleeding

Bleeding is one of the most common side effects after gastric sleeve surgery and usually comes from the staple line closure where the stomach has been divided. Symptoms could include dizziness, shortness of breath, a rapid pulse, or a pale appearance.

2. Stomach Leaks

Stomach leaks are rare after gastric sleeve surgery and occur when a hole develops along the staple line, allowing stomach juices to escape into the abdominal cavity. This can cause an infection and eventually lead to sepsis or septic shock. Symptoms include a rapid heart rate, dizziness, shortness of breath, fever, abdominal pain, left chest or shoulder pain, or abdominal distention. Diagnosis of a stomach leak can be challenging and requires further surgery to rectify.

3. Blood Clots

Obese patients are at a higher risk of developing blood clots than people in the normal weight range, but this is still a rare side effect after gastric sleeve surgery. The best treatment for a blood clot is prevention by taking blood thinners before surgery and early mobilisation within two hours after surgery to prevent the clots from forming.

4. Abdominal Abscesses

Abscesses can occur when pus collects in an area of the abdomen and can be diagnosed with a CT Scan. An abscess forming as a side effect of stomach sleeve surgery is usually caused by some of the contents of the intestines leaking into the abdominal space and can be treated by draining away the pus.

5. Would Infection

The advantage of laparoscopic surgery (i.e. surgery done through a keyhole incision) is that there is less risk of wound infection forming as a result of gastric sleeve surgery because the wound itself is so small. Some redness is expected; however, if the incision becomes excessively red and warm with a thickening of the skin and possibly some discharge, it is possibly infected. This can usually be successfully treated with antibiotics.

Gastric Sleeve Side Effects: Long Term

Long-term side effects of gastric sleeve surgery may include:

1. Stenoses

Stenosis is a narrowing of the stomach caused by scars along the staple line contracting, making the stomach excessively narrow and creating problems digesting food. This can lead to stomach obstructions but can be treated by ‘stretching’ the narrow area with a surgically inserted balloon to widen the channel. 

2. Excess Skin

Sagging skin is not so much one of the side effects of stomach sleeve surgery as a result of obesity. The skin stretches with excess weight, and it is common to be left with excess skin after any weight loss surgery. This can be rectified with a panniculectomy, which is a surgery to remove the excess skin.

3. Vitamin Deficiencies

Eating fewer calories means fewer opportunities to take in nutrients. Therefore, you have to make sure you’re eating the right foods to alleviate any side effects after gastric sleeve surgery. In some cases, whole foods may not be enough to gain sufficient nutrition and you may need to supplement your diet with vitamins, minerals, or other medications to maintain optimal health.

4. Regaining Weight

Immediately after surgery, the remaining stomach pouch is only big enough to hold one cup of food; however, over time, it will stretch if the patient begins to eat larger meals. If this happens, weight loss may come to an end, or you may even start to gain weight. While surgery is a tool to help with weight loss, it has to be accompanied by a permanent change of habits to maintain weight loss results and avoid some of the side effects of stomach sleeve surgery listed above.

How to Avoid Side Effects After Gastric Sleeve Surgery

Prevention is better than a cure, as they say, so the best way to avoid gastric sleeve side effects after surgery is good preparation before surgery. At Central Coast Surgery, our team will do everything possible to ensure you’re well prepared before your procedure. You will consult with your surgeon, a dietician, and a psychologist to ensure you’re in good mental and physical health and an appropriate candidate for weight loss surgery.

Depending on your medical history and personal circumstances, we will perform a routine blood test to establish your general health and may also utilise other tests like a chest X-ray or ECG if necessary. We also advise that you start losing weight, exercising, and changing your diet to prepare for surgery. If you smoke, we would advise you to quit before your procedure. These changes will help you to be successful in the future of your weight loss journey and will help alleviate any possible side effects after gastric sleeve surgery.

Choosing a Good Surgeon

Any type of weight loss surgery is a serious undertaking, and selecting the best possible surgeon is key to a successful outcome and avoiding as many side effects of stomach sleeve surgery as possible.

Dr Ken Wong is an experienced bariatric surgeon and an expert in the field of weight loss surgery. Dr Wong performs hundreds of weight loss surgeries a year including gastric sleeve, gastric bypass, and gastric banding surgery. All surgeries are minimally invasive and performed via keyhole to allow patients a faster recovery time. All surgery take place in private hospital facilities where you will be taken care of by our team of dedicated staff.

At Central Coast Surgery, we firmly believe that pre and post-operative care is imperative to long-term weight loss. We happily invest time and energy to educate and guide our patients through these phases. With a highly-skilled, multidisciplinary team to support you on your journey to a healthier life, we're not just here to provide surgical options, but we're here to help you successfully lose weight and keep it off.

So, if you’re considering gastric sleeve surgery in Newcastle, please get in touch with Dr Wong and the team at Central Coast Surgery today. As a specialist team, we provide patients with extraordinary results and excellent care on their journey to health. Call us on 02 4323 7000 for more information or to book your initial consultation.

How Is the Stomach Removed in Gastric Sleeve Surgery?

Posted on 22 Aug, 2021
How Is the Stomach Removed in Gastric Sleeve Surgery?

While many people are aware of what gastric sleeve surgery is, they often ask, “How is the stomach removed in gastric sleeve procedures?”. Before undertaking an operation of any kind, it is always essential to understand the processes that will occur during your procedure and the ensuing effects.

In this article, we will cover the processes during a gastric sleeve procedure, and answer several frequently asked questions, including “How big is your stomach after a Gastric Sleeve?”.

Let’s start with the basics:


How Is the Stomach Removed in Gastric Sleeve?

A gastric sleeve is a surgical procedure that removes part of your stomach and reduces its overall size to assist weight loss. Performed via keyhole, this procedure is known as a laparoscopic operation. A small incision is made in the abdomen, and the surgeon passes a laparoscope and other instruments needed to perform the surgery through this opening. Using these tiny openings, the surgeon manipulates the stomach, reducing it in volume, and removing the upper section from the body.

During the procedure, a tube is inserted into the stomach through the mouth to remove all food, gas, and liquid before any incisions. This allows the stomach to decompress and makes it easier to operate on. After the stomach has been decompressed, the surgeon can begin making incisions and inspect the stomach.

After this, small keyhole incisions in the abdominal wall are made for the placement of trocars. A trocar is a medical device consisting of an awl, canula and a seal. These are used during laparoscopic surgery and provide access points for the surgeon.

Using these incisions, the stomach is inspected, and the blood vessels to the lateral side of the stomach are divided. 

After this, a bougie tube is inserted, providing a template for which the surgeon uses to create the new stomach.


So, how is the stomach removed in gastric sleeve procedures?

Well, starting 4-6 cm away from the Pylorus, a stapler is used to divide the stomach into sections. The pylorus is the valve between the stomach and the small intestine. Once the surgeon has completed their stapling path up to the top of the stomach, the upper part of the stomach is decompressed and removed via one of the trocars. This removed section is approximately 75-80% of the original stomach leaving the new stapled stomach at about 20-25% of its original volume. 

The benefit of performing this procedure via keyhole is it reduces scarring and recovery time. This is because the smaller incisions will result in less bruising, pain, and disturbance to the rest of the body.



Gastric Sleeve Explained

So that answers the question of, “How is the stomach removed in gastric sleeve?”; but what about the "why?"

A gastric sleeve operation limits the amount of food you need to eat to feel full. The procedure is completed with the patient under a general anaesthetic, and individuals who undergo this surgery can generally return to normal levels of activity within a few weeks. The operation does not involve the placement of any foreign material like a gastric band and is irreversible. 

Not only does this surgery reduce the size of the stomach and allow for feelings of satiety to be reached with less food, but it also removes parts of the stomach that produce ghrelin. Ghrelin is produced by the enteroendocrine cells and is also known as the “hunger hormone.” Ghrelin is highest before mealtime and signals to your brain that your body is hungry. Removing the portion of the stomach responsible for its production reduces the chances of obesity behaviours such as binge eating and overconsumption.

Gastric sleeve surgery is also beneficial towards other health outcomes such as controlled obesity-related health conditions, including:

  • Hypertension
  • High cholesterol
  • Diabetes
  • Depression
  • Back Pain
  • Sleep apnoea

So, while it supports physical weight loss, a gastric sleeve procedure supports the management and elimination of many other obesity-related health problems. The amount of weight loss will depend on various factors such as age, pre-surgery weight, level of obesity, general health, ability to exercise and long-term commitment to a healthy lifestyle. 


Suitability of Gastric Sleeve

It is not only important to answer, “How is the stomach removed in Gastric Sleeve?” But also, “Who is most suitable for this kind of procedure?” This form of bariatric surgery is particularly beneficial for people who have struggled with obesity and have struggled to lose weight using other weight loss methods and exercise regimes.


suitability for gastric sleeve


Gastric sleeve surgeries are performed in both public and private hospitals, with Medicare able to cover part of the costs if the patient can satisfy obesity guidelines. The criteria are primarily based on Body Mass Index (BMI) and if obesity-related complications are present. A patient must either:

  • Have a body mass index greater than 40, this means they are overweight by 45 kilograms or more. 


  • Have a body mass index greater than 30, this means they are overweight by 13.5 kilograms or more, and be affected by at least one obesity-related co-morbid health concern. 


Recovery After Your Procedure

With a keyhole gastric sleeve procedure, patients can typically go home the day after their surgery, regardless of how much the stomach has been removed. The following weeks will consist of a slow return to normal activities and integration of new dietary considerations. For more information on the recovery process and return to activity after gastric sleeve, check out our article on when you can start exercising after gastric sleeve surgery.


How Big Is Your Stomach After Gastric Sleeve?

Between 75- 80% of your stomach is removed during the operation, with the remaining portion stapled together and formed into a sleeve. After this, the stomach has a volume of approximately 90ml. As every individual is different, so are their surgeries. The amount of stomach safely removed depends on various factors including: 


Stomach Size Prior to Surgery:  

The size of the stomach after a gastric sleeve procedure is informed by the size of the original stomach. As each individual is different, the percentage of the stomach removed during the procedure will be determined by the surgeon. As this is percentage-based, more often than not, the larger your stomach was before the surgery, the larger it will be post-op.


gastric sleeve stomach size


Bougie Size:

How big is the stomach after gastric sleeve? Well, one of the factors affecting this is bougie size. A bougie is a flexible tube used during a gastric sleeve procedure to measure the amount of stomach that needs to be removed. The bougie is inserted orally through the mouth and into the pylorus. The surgeon chooses bougie size to ensure maximum weight loss results while not jeopardising the health and safety of the patient. 


Post-operative Stretching: 

It is natural for the stomach to stretch after surgery as the body adapts to the needs of the digestive system. While some individuals may be confronted by this, it is essential to focus on more critical health metrics such as blood pressure, blood sugar and sleep quality. 


How Big Is the Stomach After Gastric Sleeve vs Gastric Bypass?

Due to the differences in outcomes and how the procedures are conducted, a gastric sleeve will leave a patient with a bigger stomach than a gastric bypass. The gastric sleeve is considered less risky and more affordable for patients. However, it is always essential to consult the services of a qualified medical professional if you are thinking of undergoing any bariatric surgery. A qualified bariatric surgeon will be able to conduct the necessary tests to ensure you are eligible for surgery and identify alternative treatments that may be more suitable to you.

The main advantage of gastric sleeve surgery is that it does not require manipulating the stomach and small bowel to create a new connection. This connection is known as an anastomosis. There is also less risk of long-term complications with a gastric sleeve procedure than a gastric bypass. With no anastomosis, there is a close to zero risk of internal hernia or marginal ulcers. With adequate diet and nutrition and consultation with qualified medical professionals, a patient should be able to achieve their weight loss goals and provide their body with all the nutrition it needs. 


How Do I Choose the Right Surgeon?

We hope that answers your queries to gastric sleeve how much stomach removed and the reasons for doing so.

When undergoing any type of surgery, it is important that you choose a surgeon you trust and who understands your situation. As weight loss surgery is all but one part of a longer journey, it is important that your weight loss surgeon works closely with dieticians, weight loss physicians and exercise physiologists. Having a team of medical professionals across all stages of your journey will provide you with a support network and the appropriate medical guidance as you progress after surgery.

It is also essential to ask whether your surgeon has had formal bariatric surgery training and experience. Qualified surgeons will be able to have gastric sleeve explained to you and perform a range of weight loss surgeries that best cater to your situation. 

If you are considering weight loss surgery, including a Gastric Sleeve Newcastle procedure, banding or bypass, get in touch with us today. Dr Ken Wong and the team at Central Coast Surgery are committed to providing the best treatment and surgical procedures to their patients. We will discuss the various options available to candidates and determine the best course of action for their situation. For more information or to book a consultation, contact the Central Coast Surgery team today