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How big will my stomach pouch really be in the long run?
This can vary by surgical procedure and surgeon. In the Roux-en-Y gastric bypass, the stomach pouch is created at one ounce or less in size (15-30cc). In the first few months it is rather stiff due to natural surgical inflammation. About 6-12 months after surgery, the stomach pouch can expand and will become more expandable as swelling subsides. Many patients end up with a meal capacity of 3-7 ounces.

What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

Why did my surgeon leave a drain in place and how do I take care of it?
The drain is called a Jackson-Pratt drain. You can see the exterior portion of the drain only. The interior portion of the drain resides inside your body and is located nearby the new connection between your stomach pouch and your bypassed limb of intestine. It has been placed as a precaution just in case your staple line leaks. If it were to leak, the drain would catch leaking stomach juices and allow it a path for removal from your body so as to prevent you from getting sick. Care of the drain is simple and requires that you empty the drain every 24 hours or when it fills up. You should record the amount of fluid in cc (cubic centimeters) every time you empty the drain and write it down on your log sheet which you would have received when you discharge from the hospital. Also, your discharging nurse should go over drain care and how to empty the drain prior to discharge.

Can my stomach pouch stretch and will I need revision if it does?
Yes, your stomach pouch can stretch over time particularly if you eat too much, too often. In general, most patients will not need revision of their gastric bypass since the opening between their stomach pouch and intestine is very small and will not allow rapid stomach emptying. Thus, patients will still get sick and possibly throw up, even if their stomach pouch has stretched a little. It is important to listen to what your body is telling you. As the pouch stretches to accommodate larger meals it is frequently accompanied by pain. This sensation (pain, nausea, etc) is your pouch telling you to slow down or stop eating. Some patients may gain a few pounds when their stomach stretches but usually not more than that.

"I know that my""new stomach"" is now very small, what happens if I accidentally swallow too large a piece of food?"
If food becomes stuck, then it may have to be removed endoscopically. Thus, it is important to chew your food very well. In a similar vein, patients who eat too much too quickly will develop intense abdominal pain followed in most instances by vomiting. This usually resolves the pain. If your pain does not resolve in a few hours, notify your surgeon.

"What are the signs and symptoms of a ""stenosis""or""stricture"" of the gastrojejunostomy?"
Vomiting and diet intolerance as well as the sensation of food being stuck in your esophagus. Sometimes patients complain of increased saliva production and an inability to swallow their own saliva. This condition is usually diagnosed by your surgeon by listening to your symptoms and possibly obtaining X -ray studies. Treatment is by endoscopic dilation and may require multiple dilatations.

Is it true that my bowel movements and flatus will have a different smell?
Some patients will complain that their flatus is particularly foul smelling, however, most patients do not notice a difference.

What is Dumping Syndrome?
"Eating sugars or other foods containing many small particles when you have an empty stomach can cause dumping syndrome in patients who have had a gastric bypass or BPD where the stomach pylorus is removed. Your body handles these small particles by diluting them with water, which reduces blood volume and causes a shock-like state. Sugar may also induce insulin shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling: you break out in a cold clammy sweat, turn pale, feel ""butterflies"" in your stomach, and have a pounding pulse. Cramps and diarrhea may follow. This state can last for 30-60 minutes and can be quite uncomfortable - you may have to lie down until it goes away. This syndrome can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be well tolerated at the end of a meal."

What are adhesions and do they form after this surgery?
"Adhesions are scar tissues formed inside the abdomen after surgery or injury. Adhesions can form with any surgery in the abdomen. For most patients, these are not extensive enough to cause problems. It is felt that the number of adhesions formed is less with laparoscopic surgery as compared to ""open"" surgery."

What happens to the lower part of the stomach that is bypassed?
In some surgical procedures, the stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known.

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