Make no mistake, undergoing bariatric surgery represents a major decision. Even those who are perfect candidates and stand to enjoy significant health and life benefits should not see it as a cure-all.
In fact, bariatric surgery is just part of a total approach to health – even if it is a drastic and necessary tool for those battling chronic obesity.
The doctors, nurses and staff at Longstreet Clinic’s Center for Weight Management understand this approach and ensure that their patients understand it too. That is why they take the time to confirm that every bariatric surgery candidate understands each aspect of the different operations and their aftermaths before they decide on whether to pursue it.
Experienced and careful surgeons such as Miguel B. del Mazo, M.D., M.S., FACS, take the time to not only explain the step-by-step process of procedures such as the gastric sleeve (or sleeve gastrectomy) and the gastric bypass (also known as the Roux-en-Y procedure), but also listen to any questions their patients may have.
During the gastric sleeve, surgeons remove a large portion of the patient’s stomach and leave the remainder in the shape of a tube or sleeve. This operation drastically reduces the patient’s need to eat large portions to feel full. It also helps decrease the production of the hormone ghrelin, which causes feelings of hunger, thus making the patient less subject to food cravings.
In a gastric bypass, meanwhile, doctors divide a golf ball-sized part of the patient’s stomach – called a pouch – from the rest of the stomach. The result is that ingested food only enters the smaller portion (pouch). This restricts the amount a patient can eat and makes them feel full quickly. It also changes gut hormones – meaning patients feel full longer. In fact, appetite suppression is a key part of long-term weight loss.
Dr. del Mazo notes that many of the patients he sees have very specific questions about pouch and sleeve size. They want to know what happens to their digestive tracts long-term – specifically, can the changes made during either the sleeve gastrectomy or bypass be stretched back out over time and wind up similar to the original stomach?
And while the surgically altered stomach will occasionally stretch – he assures that it will never be the same as an original stomach.
“It’s kind of an interesting question for me because I think the stomach is designed for a certain amount of stretch. When we eat with a standard stomach, there’s going to be a little bit of stretching that goes on there. That’s a normal part of the digestion process,” Dr. del Mazo said. And after a sleeve or a bypass, that’s going to happen again. But I don’t think the stomach chronically deforms. It doesn’t change its shape or size long term in a way we can’t work with the patient to restore.”
In other words, the altered stomach always retains some elasticity.
“You can imagine after a standard meal, you eat, you get full, you then digest that food, and the stomach gets smaller again. Long term with a gastric bypass or sleeve, the same process is happening, but over time you can train that new stomach – that pouch, that sleeve – to accommodate more food,” Dr. del Mazo added. “The way I describe it to patients is think about those guys who eat 80 hot dogs on July 4th for competitions. They’ve got the same size stomach that I do. But if you were to put a camera down the next day and look at their stomach, it’s the same as mine. But what is different is that their stomach can stretch and stretch and stretch and not complain, not cry out and say, ‘Hey, quit eating!’ And so, they’re able to compete in food eating competitions – I couldn’t do that.”
However, the stretching that takes place in a patient after bariatric surgery is relative. And the sleeve and pouch size remain smaller for life.
“In a sleeve surgery, you are resecting or taking out about 4/5ths of the original stomach, so, no, it’s not possible to stretch out that much over again,’ Dr. del Mazo said. “With a bypass patient, the pouch is about 20-30 milliliters in size, compared to a stomach that’s normally a liter in size. So, it’s much smaller than the original stomach. There’s no amount of stretching that goes on to the degree that original stomach would have. But it’s more about what the stomach learns to accommodate without complaining about.”
That means patients, who are initially severely limited in how much they can eat following surgery, can, over time, teach their stomachs to take in larger portions.
“A sleeve or a bypass long-term, it’s possible to be able to train it to not be as upset about going over the 4-6 ounces we recommend per meal. And so, getting a patient who’s doing that 8-ounce or 10-ounce or 12-ounce meal back down to a 4 or 6 is usually a process of training and retraining the stomach by decreasing portion sizes, by picking good satiety level foods like proteins, vegetables and watching out for breads, rice, pasta, and potatoes. So, it really isn’t so much that the stomach stretches and deforms but basically it does the job that you ask it to do. And it gets better and better at that job,” Dr. del Mazo said.
That is why it is so important for bariatric surgery patients to understand that – even after an operation – addressing obesity is a lifelong health approach. The surgery itself kickstarts significant weight loss, but lifelong health must be supported by proper diet, including consistent consumption of water and vitamins and the avoidance of starchy, sugary foods.
For those suffering from chronic obesity – and the other conditions that stem from a Body Mass Index of 40 or above – it is often a choice worth making.
If you find yourself in this situation and are considering the benefits of bariatric surgery, the caring and experienced providers at the Center for Weight Management are here for you. We will work closely with you to determine the health track that serves you best. Visit www.longstreetclinic.com/specialties/center-for-weight-management/ to learn more or contact Dr. del Mazo and his experienced staff today at 770-534-0110.
