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I am afraid of my pouch stretching after bariatric surgery!

Pouch stretch is a common concern of patients after bariatric surgery.  They may worry that their pouches will stretch and they will be able to eat large portions of food again.  The good news is that your smaller stomach after gastric bypass or sleeve gastrectomy will generally not stretch up to the size of a normal stomach.  Whenever we perform a CT scan, contrast swallowing x-ray test, or endoscopy of the stomach pouch, we typically find that the pouch is the same size years after bariatric surgery.

How then can people eat slightly larger portions years after weight loss surgery?  Part of the answer lies in the “compliance” of the pouch.  Compliance describes how easy it is to distend something.  Imagine a balloon fresh out of its package.  When you first try to blow it up, it will be difficult.  But after blowing it up and deflating it 100 times, it will be easier to blow it up the next time.  You will not have to blow as hard.  The balloon will be so compliant, that it won’t take much pressure to inflate it.  But the balloon has not really “stretched” per se.  When you deflate it, it is still the same exact size as it was when you first took it out of the package.  The volume of the balloon is no larger.

The same is true of your stomach pouch.  Even though it will still be small years later, it will be easier to fit more food in it if you try.  I always tell my patients that just because you can eat something, it doesn’t mean you should.  Even with increased compliance, I have found that 5-7 years after bariatric surgery people still can’t eat as they could prior to surgery.  Portion sizes remain limited so your pouches are always there for you, ready to help keep your weight under control.

Carl Lowe, Jr., MD

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