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Friday, April 01, 2005

Stretching the Stomach Pouch

During our recent vacation I was sick & vomitting once (march 30) for overeating, eating to quickly and not listening to my tummy scream "STOP FEEDING ME!" This got me to thinking: Is it possible to stretch my stomach pouch back to pre-surgical size? Here's what I learned:

Bariatric patients fear that over time their new tiny tummy will return to normal size. This fear could be founded on the experience of early stomach stapling patients who in the 1970’s and 1980’s had surgery, and later regained the weight they had lost. The stomach was divided with a row of staples, the smaller part accepting food, the larger part a void. Over time the staples dissolved and food was allowed to enter the voided stomach. Soon, the staple partition was gone and the stomach was normal sized. As a result, patients could eat more and many regained the weight they lost initially. Today, this method of stomach stapling is seldom done.

The gastric bypass, now considered the premium operation in the treatment of morbid obesity, is a refined surgery that capitalizes on the experience of stomach stapling and later the Fobi Pouch to produce the maximum sustained weight loss achievable.

The operation achieves its favorable lasting results by creating a very small stomach pouch the size of an egg. The rest of the stomach – the inactive stomach – is permanently divided and separated. The small intestine is cut about 18 inches below the stomach and re-arranged to provide an outlet for the new tiny tummy. The flow of digestive juices is maintained, the stomach functions normally, just tiny sized. The lower part of the stomach is bypassed and food enters the second part of the small bowel within about ten minutes of beginning a meal. Because the stomach is permanently divided and separated from the large stomach the tiny pouch cannot return to its original size.

The stomach is a muscular sack between the esophagus and the small intestine. It is able to expand when food enters it because it is two layers of vertical and horizontal muscle that stretch to accommodate the food. When the stomach is full the walls are thin and stretched, like a balloon filled with air. When the stomach is empty the cavity becomes almost flat and the stomach walls are thicker; the muscles relaxed. A normal stomach can hold about 1.5 quarts of food and liquid volume. The tiny tummy can hold about one cup.

Because the muscles expand and contract to accommodate food it’s natural to think the stomach is growing when full of food. The stomach does get larger while filled with food, but contracts back when empty. This is a natural muscular reaction. It will not grow back to normal size after gastric bypass surgery

Gastric bypass is successful, in part, because of the way the stomach muscle expands when filled with food. With your original stomach you had to eat nearly six cups of food before your stomach muscles were stretched and you reached a feeling of satisfaction. No wonder we had to eat so much! Now with your tiny tummy, you reach that same satiated state after eating less than one cup of food. A feeling of fullness is achieved almost immediately when eating. When your pouch is full there is no hunger and no feeling of deprivation.

Remarkably, when your tiny tummy is full you will feel indifferent to food – even the most tempting delights lose appeal. Thinking back to our obese days, how many of us can honestly say we ever felt indifferent to food? It is crucial to be alert for the signals the tiny tummy sends and quit eating when full. If you find it difficult to stop eating until you are glutted and possibly vomiting it is often effective to measure food portions. Our eyes are not always accurate measuring devices when it comes to the things we eat.

(This is where I made my mistake: I did not measure a reasonable portion of a Chinese food that can be consumed too quickly resulting in illness before I realized what I had done to myself.)
The stomach muscles perform another function. When food enters the stomach the muscles contract rhythmically. The muscular contractions send a series of wavelike motions from the upper end of the stomach to the lower end and they mix up the partially digested food with the stomach secretions making a thick soup. Listen closely; you will hear your tiny tummy churning. The muscle contractions then move the soup into the small intestine. Interestingly, even though most of the stomach is now detached and inactive, it still grumbles and contracts as it produces stomach secretions.

Bariatric surgeons say the tiny stomach pouch does not stretch or grow over time, but most agree the fear of causing that to happen is an effective incentive to prevent patients from overeating. One woman was so afraid she would stretch her pouch she started a stringent monitoring system. She surveyed several meals to determine how many bites she could take before feeling full but not glutted. Once she learned how many bites to take she refused to exceed that. She was determined to never stretch her pouch and regain the weight she worked so hard to lose. Now that’s self control!

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