Question:
How many have a stretched pouch confirmed by a surgeon?

Everyday posters ask, have I stretched my pouch? My surgeon says its a overrated problem. I am curious. How many have had a streched pouch confirmed by your surgeon? What did the suurgeon suggest you do? Lets not include staple line disruptions and VBG failures but just RNYers with stretched pouches. Is anyone out there?    — bob-haller (posted on January 19, 2003)

January 19, 2003
I would like to know this also, as I have a good friend who had this surgery about 7 months ago, and I am having it this spring. She is always talking about stretching her pouch-- she is afraid she is doing it. But I wasn't sure if she actually was or if there is just more fear in doing it that actually doing it. What really does stretch your pouch??
   — Erin Z.

January 19, 2003
First, let's define what we mean by a "stretched pouch." Here's an excerpt from one of the versions of the Pouch Rules:<P>"What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal?<P>"For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. <B>Most pouches ended at 6 oz., with some as large at 9-10 ozs.</B><P>"We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, <B>THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS.</B> This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible."<P>This article appears at http://www.nikkiinmd.com/pouch_rules.htm , where they credit it as follows: "Original article written by: Mason. EE, Personal Communication, 1980. Barber. W, Diet al, Brain Stem Response To Phasic Gastric Distention. Am J. Physical 1983: 245(2): G242-8 Flanagan, L. Measurement of Functional Pouch Volume Following the Gastric Bypass Procedure. Ob Surg 1996; 6:38-43."<P> Whew! When all is said and done, I take it from this article that the pouch is *supposed* to stretch. We're supposed to learn to eat more, gradually, as we recover from the surgey. It's when we flat-out binge, and put relatively worthless foods into it, that we run into problems. Just like before surgery. :(
   — Suzy C.

January 19, 2003
I don't have much to add about the pouch stretching issue, but my surgeon did tell me that my stomach pre op was about the size of one of those glass jars that docs have in their offices, you know the ones, they hold the cotton balls and tongue depressors. So if my pouch stretches a bit, so long as it doesn't get that BIG again...it's all a matter of how you look at it. Have a Sparkling Day!! ~CAE~
   — Mustang

January 19, 2003
My surgeon told me that in the "old days" he used to make the pouches 3 oz., but they stretch to about 12oz. So now he makes them 1 oz and they stretch to about 3 oz. And that this is normal.
   — Haziefrog

January 19, 2003
surgeon said pouch was stretched although it was started by line disruption
   — snicklefritz

January 19, 2003
Hi, I can attest to this one. I am 18 months post op. I loast 65 lbs in the first four months and have lost nothing for the past 14. I recently had an endoscopy and upper GI series. My pouch is stretched and my stoma is dilated. i am having a revision to the BPDS
   — vicki V.

January 19, 2003
Mine was noted as "slightly stretched", though the stoma is intact. Of course, been using it for awhile, too. But I've met many more whose stomas have relaxed than whose pouches are actually stretched.
   — vitalady

January 21, 2003
Hi Bob: I have heard about a complication called "large stoma syndrome". Are you talking about that? From what I have read, those poor people are unable to lose and treated like dirt by their doctors, being told that they just have to exercise control. As a matter of fact, they cannot. Their pouches, from what I understand are able to handle almost what they could eat postop, only with the malabsorption component still intact. They do lose weight, but are hungry almost from day one. One woman who had this condition, said that her surgeon or any other surgeon for that matter, could not do anything, and to just go on a diet! If this is not what you mean, I am sorry. But I feel so bad for these people, after going through major surgery, to be just told to diet again. It is also tougher to diet for LSS people, because they do not have the smaller stomach. From what I have been told, this problem is becoming more frequent, because of the greater number of WLS being done. Love Grace
   — Grace H.