Understanding Your New Roux-en-Y Gastric Pouch

After Roux-en-Y Gastric Bypass surgery patients are left with a tiny new stomach - often called a "pouch." Although the pouch starts out very small immediately after surgery, it changes over time. The remaining small intestines also change. Understanding the anatomy of your digestive tract will help you formulate behavior patterns to use your new tools in the most effective manner.

How can our RNY stomach pouch work for the rest of our lives? Does my pouch stretch? Why can I eat so much food? How does malabsorption work? Knowing how your pouch works after surgery and tailoring your eating to accommodate it's anatomy and function will help you be a success.

Your original stomach (before surgery) could hold up to 4 liters of food (that's 16 cups!!). Your new pouch, at the time of surgery, was about 1ounce and could hold about 2 ounces of food. Your surgeon made your pouch out of the least-stretchy part of your stomach (the Fundus), so it's difficult to stretch it.

BUT...

Our pouches will GROW over time. Yes, it's a living organ and your body tries to compensate for the rearranging we did to it during bariatric surgery and it will grow to help get in as much nutrition as possible. A mature pouch is anywhere from 6 ounces to 9 ounces in size... and can naturally stretch to hold up to 12 ounces of food at a time. A pouch reaches maturity at about the 2-year mark. By 6 months after RNY gastric bypass surgery your pouch has grown to about 2/3 of it's maturity level. Once you are a year out, your pouch is no longer 1 ounce in size ... it's more like 3 ounces or 4 ounces and can hold 6 to 8 ounces of food.

Studies have shown that the size of your pouch has very little to do with your overall success with weight loss.Your success has more to do with how well you follow your eating and exercise plan and how well you follow the "rules of the pouch."

Also remember that your body immediately begins to compensate for the gastric bypass surgery. Once your body realized that a portion of your intestine has been bypassed and you aren't absorbing all the calories you're eating, it begins to figure out how to become more efficient. Your intestines grow additional villi along the intestinal wall -- the little finger-like tentacles that grab nutrients/calories as food passes by. No, we won't ever replace those first 100-150cm where various vitamins are absorbed, so we'll always malabsorb nutrients (thus the need for lifetime vitamins and minerals). But the body figures out how to absorb all the calories we eat eventually. By the 2-year mark you're likely absorbing every single calorie you eat.

As for not feeling full -- that's perfectly normal. The nerves in our stomach were cut during RNY gastric bypass surgery when your surgeon was forming your new stomach pouch. These are the nerves that signal to our brain when we are full or hungry. In some people those nerves repair themselves as early as 3 months post-op, but for others it might take 18 or 24 months for them to start working again. And often they don't have the same "signal strength" as they once had before surgery. So that's why it's so important to always measure/weigh the food we eat to avoid overeating.

By ALWAYS following the rules we were given we will always be able to effectively use the tool we have. Weigh and measure your food; eat on a schedule with no grazing or unplanned snacks; protein first; NO drinking with meals -- that's a big rule that so many people get lax on the further out they get. Once we fall back into that bad habit, we have basically rendered our tool useless. But once we stop drinking with meals... we realize the pouch tool still works just fine. And that's just one of the rules we follow.... have to keep them all at the top of our list.

So yes, I firmly believe the tool continues to work for the rest of our lives. As long as we protect it and be kind to it. But by understanding that it grows, matures and changes over time is very important when you have to adapt your behavior to what's going on inside your body.