Temporary stretching of the stomach is a normal phenomenon that occurs after eating a large meal. However, permanent stretching and dilatation of the stomach are one of the major underlying factors in obesity. A large stomach accommodates a large amount of food and does not allow for the early sensation of fullness. This excessive calorie intake is central to the pathogenesis of weight gain. Treatment of obesity has therefore revolved around limiting the stomach capacity to achieve early satiety and prevent excessive calorie intake.
Most non-surgical weight loss programs failed to achieve satisfactory weight reduction due to the inability of the individual to reduce food intake as the stomach is already stretched and enlarged with an increase in appetite-stimulating hormones.
The stomach mucosa (lining) has folds known as “rugae”. In addition to the muscular wall of the stomach, the rugae allow the stomach to expand and accommodate more meal. With digestion and emptying of the stomach content into the small intestine, the stomach gradually returns back to its pre-meal size. In obese individuals, the imbalance between satiety and appetite hormones (in favor of the appetite hormones) results in excess food intake and permanent dilatation of the stomach. This permanent dilation further increases the calorie intake resulting in a vicious cycle. The excess calorie is then converted to fat resulting in obesity.
Gastric sleeve surgery is a restrictive bariatric surgery with proven effectiveness in achieving weight loss and reversal of comorbid conditions. It is safe and associated with relatively fewer complications. The surgery entails the reduction of the stomach size to as much as 10% of the original size. This is aimed at reducing its capacity in order to get an early sensation of fullness after taking a small amount of meal.
After gastric sleeve surgery, the early satiety should lead to small food intake with weight loss. Those that refuse to stop eating after feeling full may have stretching and permanent enlargement of the new stomach. This is not unconnected with the fact that the new stomach is similar to the original one in terms of mucosa lining and muscular wall. Enlargement of the stomach due to dietary indiscretion may, therefore, be counterproductive and ultimately result in inadequate weight loss or regaining of the already lost weight.
With regaining of the already lost weight, there may be worsening of comorbid conditions.
The most obese patient may be thinking gastric sleeve surgery is a waste of time, as the stomach can stretch to its original size after the surgery, and may, therefore, see no reason for doing the gastric sleeve. However, it is important to note that stretching may be inevitable but the degree of stretching that leads to inadequate weight loss is completely preventable by strict compliance with dietary and exercise plans.
Never disregard the sensation of fullness after gastric sleeve surgery. It is the major mechanism through which you get to know when to stop eating. Stop eating immediately you feel the sensation of fullness. Most surgeons will provide adequate counseling on healthy dietary habits and the need to initiate and maintain these habits for a significant period of time before the surgery. Those who adhere to their dietary and exercise habits before surgery often have less difficulty sustaining them after surgery.
The small amount of food should be eaten at a time to avoid stomach stretch. Do not drink water simultaneously with food but at least 30minutes apart. Avoid all refined sugar drinks and carbonated drinks as they contain gases that can cause stomach stretching.
Many interventions are available when stretching or enlargement of the stomach has hampered weight loss. These include pouch reset, re-sleeve, and conversion to gastric bypass or duodenal switch. Nevertheless, a thorough assessment of the cause(s) of the stomach stretch and dilatation should be made and addressed as they may also hamper the success of the revision surgery.
In conclusion, stretching of your stomach can occur after gastric sleeve surgery and this can cause inadequate weight loss and worsen of comorbid conditions. Although stretching of the stomach may be an inevitable occurrence after gastric sleeve, adherence to healthy dietary and exercise plans will help limit the stretching and prevent inadequate weight loss.