Why don’t I feel a restriction 3 weeks after my VSG?

Question

Surgery and recovery all went smoothly. The first few days of puréed I easily felt the restriction after a few bites. Now, i don’t feel anything. I’m still on soft foods. I’ve been able to eat more than 1/3 of a cup, more like 1/2 because I haven’t tried to push it, and not feel full. Why don’t I feel a restriction anymore? Despite the weight loss This surgery is disappointing so far. I worry my surgeon didn’t use the right boogie size.

Ali Solmaz, MD · Answer

I understand your concern, and it's completely normal to feel this way, especially early in the healing process. There are a few reasons why you may not be feeling as much restriction at three weeks post-op, even though your surgery and recovery went smoothly.
In the first couple of weeks after surgery, your stomach was swollen, which made it feel much tighter. That swelling is now subsiding, which can temporarily make it seem like you can eat more. This doesn’t mean your stomach is too large; it’s just part of the healing process. Another factor is the type of food you are eating. During the puréed phase, thicker foods stayed in your stomach longer and created a stronger sense of fullness. Now that you're on soft foods, they may be passing through your stomach more easily, which can make you feel like you’re eating more than expected.
Additionally, the nerves in your stomach were disrupted during surgery, and it takes time for them to heal. Right now, your "fullness signals" may not be functioning as they normally would, which means you might not feel restriction as strongly. This is a temporary issue, and as the weeks go on, you should start recognizing fullness cues more clearly.
Portion control is also important at this stage. If you're eating soft foods comfortably, it’s easy to consume more than intended without realizing it. This doesn’t mean your sleeve isn’t working, but rather that you might need to be extra mindful of how much you're eating. Measuring portions, eating slowly, and focusing on protein-rich foods can help you gauge your restriction better.
If you’re worried about the bougie size your surgeon used, keep in mind that most surgeons use a size between 32 and 40 Fr, and even on the larger end, your stomach is still significantly smaller than it was before surgery. The sensation of restriction is influenced more by healing, eating habits, and food texture rather than just the size of the sleeve.
As you progress to solid foods, you’ll likely notice a stronger restriction. If you continue feeling no restriction at all over the next few months, it would be worth discussing with your surgeon. For now, try not to worry too much, and trust that your body is still adjusting.

Pablo Garcia, MD - Account Suspended · Answer

Hello, I hope you are well. If you are no longer feeling restriction after your gastric sleeve, your sleeve is probably adapting to food volume. If you were previously feeling restriction, it is possible you are eating a greater amount of food than advised, which is causing said adaptation. I would recommend you bring this up with your nutritionist and bariatric team.

Mark Pleatman, MD (retired) · Answer

It's hard to say what the problem is, or if there even is one.  You will have to wait and see.  Some surgeons say that it doesn't matter what size bougie  you use when doing the surgery.  Of course you can make a huge sleeve even though you use a small bougie, if you don't staple close to it.  I've seen some big sleeves and poor weight loss.  But have faith that your doctor did a good operation, and stick with the program.

Why don’t I feel a restriction 3 weeks after my VSG?

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