Pouch size increase

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Dear Brenda,

Several things can happen as time goes by. Your pouch can stretch a little. The gastrojejunostomy (the connection of pouch to the small intestine) can widen. You can change your dietary habits to accommodate more food. You can eat richer food with more calories per serving. There may be changes in your internal metabolic signaling that alter your weight set point and make you hungrier. All of these changes can result in greater calorie intake and result in weight regain.

One way to estimate your "pouch size" is to obtain an 8 or 12 oz container of large curd cottage cheese and see how many ounces you can eat in 5 minutes.

Another way is to undergo an upper GI series with food. You bring a sandwich to the x-ray lab. The radiologist does an initial barium swallow. Then the technician puts some barium paste on the sandwich. You eat the sandwich. You and the radiologist see how big the pouch is and how wide the stomach-small bowel connection is when the food enters the stomach. It's a great educational experience if you can watch it on a monitor. Once you see what's going on you will be able to change your behavior to optimize your eating. 

Doing revision surgery to make the pouch smaller or decrease the size of the gastrojejunostomy is controversial. It may help for a while, but all too often the effects are minimal and short lived. Many people adjust their eating style and don't lose or keep off much additional weight. There may be isolated cases where pouch or anastomosis reduction procedures have beneficial long term results, but there's not much in the surgical literature to support these procedures.

I've attached an article which you can download that summarizes causes and treatments of weight regain after gastric bypass.


1996 Feb;6(1):38-43.

Measurement of Functional Pouch Volume following the Gastric Bypass Procedure.



The cottage cheese test was developed in an attempt to find a simple way to measure functional pouch volume and to better understand the fate of the tiny proximal pouch following the gastric bypass procedure.


Our patients were asked to eat cottage cheese in a structured fashion before their return visits from 3 months to 2 years postoperatively.


We found there was a step-wise progression of increase in functional pouch volume with statistical significance between each time interval. Also, we compared the patients' excess weight loss at 1, 2, and 3 years postoperatively to their pouch size at 1 year postoperatively. Although there is a wide range (2.5-9.0 oz) of pouch sizes at 1 year, there is no significant difference in excess weight loss between the smaller and larger pouches.


The pouches enlarge by the orderly process of hyperplasia. Within the 2.5-9 oz volume variation, the pouch volume alone is not a predictor of weight loss. Rather, how the patient uses the pouch/tool, in addition to the other behavior modifications, determines the degree of weight loss. This data strongly suggests that the surgeon's understanding of and teaching of the optimal use of the pouch/tool may be more important than previously thought.

Maleckas 2016 Weight regain after gastric bypass.pdf

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