Reasons for pouch enlargement?

Hi all: My endoscopy revealed that my pouch has enlarged significantly, although I have been pretty careful about my food intake since my surgery in 2002 ****pt a food diary for 8 weeks prior to my first appointment to discuss revision) and exercise fairly regularly. I have regained about 50 of the original 70 I lost (I never did make my goal). I have requested a revision surgery due to my expanded pouch, although it has been denied by insurance because they assume it is because of overeating. My GP will need to speak directly to the insurance people; however, I'm not convinced that he is knowledgable enough about reasons for pouch enlargement to convince them that I need it. (I could be wrong, though!!) Does anyone have a layman's guide (for me) as to why the pouch would have expanded? I'm sorry to be so ignorant, but it's more that I want to make sure that neither I nor my doctor say the wrong thing to the insurance people. My surgery is already scheduled for July 14, so I need to have my GP speak to the insurance people tomorrow at the latest. Any advice? Thanks so much!

Check out this link... the Dr. explains it very well... http://www.obesityhelp.com/forums/revision/board_id,5360/cat _id,4960/topic_id,3582993/a,messageboard/action,replies/#282 29403 Good Luck!

I had my lap RNY surgery in June 2001 and I can tell you why my pouch is 500cc.   My new surgeon told me.  The surgeon who did my first surgery lap  didn't want to stretch the intestines too much to reach my pouch.  So to correct himself he made my pouch too large.  He also used the wrong section of my stomach.  There are parts of the stomach that stretch more than other parts.    So much has been learned since 2001 about weight loss surgery and I am sure he has more experience now. I am having a revision July 3rd.  My new surgeon is redoing my pouch and stoma.  I will be just like a newbee.  I have a medical reason for my revision.  I burp constantly and have reflux.  My insurance has a clause that does not cover the surgery or anything to do with the surgery.  So, I am self pay.

I'm sure the surgeon in the link explained it in such a way that getting a revision covered may be possible. I was told by my surgeon one of the fastest ways to stretch the pouch/ and or stoma was to always overeat, push that last bit of food in even when you're already full. Along with that is not chewing your food well. With a RNY pouch, not as much digestion takes place in the pouch because of a lack of some digestive juices. So large chunks of food end up being pushed through the stoma by more food or by liquids and this helps stretch the stoma. When the pouch and stoma are stretched, your intestines end up filling up with the food that is too much for the pouch. This basically defeats the surgery. I am not suggesting it's anyone's fault. I'm jsut saying what my surgeon told me in order for me to help myself to keep the weight off. Shouls I gain anyway while following all the rules, then I guess I'll be looking for a revision, too!

Thanks for your responses. I actually have been following the rules and despite that have had stretching. The surgeon only explained that it does happen and stretching occurs naturally; however, did not give any specific reason that I can tell the insurance company. The insurance specialist said something about vomiting stretching the pouch - is this so?

It may well be a factor, and for some people, having their stomach altered may cause them to have some vomiting episodes. This certainly would be a side effect of the original surgery.