I was sleeved September of 2016 and I've only lost 40 pounds. I don't feel like he made my stomach small enough. Options?

this is not as rare as you might think. the best option for this is conversion to duodenal switch. this operation causes weight loss in a different way. I always check the sleeve and occasionally trim off excess sleeve if needed. about 50% of my practice is revision of previous bariatric operations. converting sleeves to bypass does not usually yield very dramatic weight loss. the DS is the way to go for failed weight loss after sleeve. 

This happens some times.  I am an experienced bariatric surgeon, and every once in a while you get a patient that can eat large meals after a perfectly done sleeve.  Not sure why this happens.  We always use the same bougie size and follow the same protocol when doing sleeves.  What i tend to do in these cases is that I take these patients back to surgery and re-dissect the sleeve.  I make sure to remove any fondus (stretchy part of stomach) that was left.  I then pass a slightly smaller bougie and tighten the sleeve over the smaller bougie with a running imbricating suture.  I have been very successful with this technique.  I generally try not to re-sleeve.  There is hardly enough stomach left for re-sleeving and strictures and leak rates are higher with re-sleeve.