Gastric sleeve volumes and MTV
What volume fits into a gastric sleeve stomach after sleeve gastrectomy?
The maximum tolerated volume (MTV) or gastric volume reflects the size of the bougie* used during surgery and the time elapsed since surgery.
Straight after surgery, the volume is somewhat predictable but within quite a short period of time, the sleeved stomach stretches.
The sleeve gastric volume increases as the months go by and appears to stabilise about 2 years after surgery with sleeve volume increasing by a massive 50% at 12 months after surgery. This increase in capacity shows you that you need to take advantage of the early months after surgery, when the stomach-sleeve is still firm and small to maximise results.
At the OSAANZ Conference in 2012, Catherine Jarman reported at 2 yrs after sleeving, a 250 ml MTV gastric capacity with 40 F bougie compared with 330 ml MTV with 50 F bougie. That's quite a difference in capacity that can explain why some people with sleeves are able to consume a lot more than others a few years out from surgery.
Why does the sleeve stretch out? We don't know for sure and I can only be theoretical about this. The ordinary stomach is a very stretchy organ that stretches and shrinks to suit the the amount of food and drink it receives. This research suggests that either the sleeve-stomach doesn't shrink back fully after it gets stretched or the body is attempting to restore the stomach's capacity to a more 'normal' volume through some kind of adaptive process.
Bottom line? Do not over-stress the sleeve. Do not over-fill it. Learn your limits early and don't keep pushing them.
*a bougie is the calibration device that surgeon uses to work out how big to make your new stomach. Basically it is like a tube that is placed inside the stomach. The surgeon then snugs his staple-cutter up against the outside wall of the stomach and tube while stapling and cutting away the remaining stomach. F is a size reference - the smaller the F, the smaller the sleeved stomach's capacity. A too small a bougie may increase complications (leaks, strictures) whilst a too large a bougie could lead to lack of restriction and possible dilation of the sleeve and so failure of weight loss (or long-term weight regain). The optimal bougie size is said to be 32-36 F but this is best discussed with your own surgeon.