Are there important aspects of the anatomy that help with long term weight control?
Yes. The original size of the pouch is important-if it is too large it may enlarge substantially over time and result in becoming a “second stomach.” The most common initial size of the pouch is 10-20cc – less than an ounce. The small pouch must also be created in such a way that it has a small outlet. This outlet is also called a “stoma.” For the gastric bypass, the surgeon should be meticulous in creating the outlet correctly since small differences in technique may result in outlet, or stomal, enlargement. If the outlet is too large, food will not remain in the pouch long enough to provide the feeling of satiety (lack of hunger). Maintaining that feeling of satiety requires keeping the pouch stretched for a while after each meal. This also involves not drinking during, or shortly after, meals. High calorie liquids (concentrated juice, milk shakes, thick cream soups, etc…) will result in weight gain. Some surgeons believe that changing the length of the roux limb may result in addi
