Pouch stretch or the opening?

I'm confused!  Still trying to learn about all of the ins and outs of this surgery.  Does the pouch stretch which causes weight gain or is it the opening at the end of the pouch....stoma?  I was told the pouch doesn't stretch that much, its the opening at the bottom of the pouch that gets bigger which allows the food to go through easier therefore allowing you to eat more and gain weight.  Is that correct?  That would make sense then as to not drinking while eating or soon after so the food is not pushed through.  That visual would help me keep from drinking!  Thanks for any help anyone can give me! 

Either can stretch although I believe it's more common for the stoma to stretch.  I don't think it's real common for anything to stretch, though.  If you chew really well, that should help prevent stretching the stoma.

Drinking while eating, especially if you do not chew your foods well, over time, can put a lot of pressure on large chunks of food to pass through the stoma, causing it to be stretched. There are a few procedures to fix a stretched stoma, but I haven't heard good long term reports on it (but have heard bad long-term reports).... in terms of mechanical malfunction of the surgery, this is one of the biggest ones. The pouch itself stretches and matures to a larger size than straight postop, and this is GOOD... I haven't really heard very many people who have stretched their pouch itself into a size that results in weight gain. It's a big fear, but I really haven't heard of anyone who has a confirmed stretched pouch.

MOST people, even those who have regained, even regained near to original weight, have a fully functional pouch and stoma...... but they eat around the rules, grazing all day, drinking while eating and getting their pouch emptied quickly...... for those people, going back to the basics will serve them well..... but you have to follow the basic rules or you might have issues with regain!

Thanks, you make really good sense.  I have always been under the thinking that the pouch stretches for some reason....the stoma too but wasn't sure how the 2 went together.  Now I have a clear picture of it.  Not chewing well and having chunks and then drinking makes for a heavy pouch.  It has to go somewhere so its forced through the stoma whether its ready or not.  Is that correct?  Or do I have the stoma in the wrong place.  Better look that one up.  I know the pouch stretches to a larger pouch after surgery and I guess we would hope for some stretching to be able to eat more regular food once we are healed.    How long were you on liquids?  Everyone is different!  I don't want to mess this one up.  When I had my sleeve I was a grazing all day and drinking with meals but the drinking with a sleeve is different than drinking with a RNY.   I certainly have changes my grazing habits over the last 2 months when my diabetes came back!  I can't wait for my revision to the RNY!  Thank you so much! 

How long someone is (or is NOT) on liquids post-op has nothing to do with the healing of the pouch or stretching of pouch or stoma.  It is purely a matter of surgeon preference.  Some surgeons, like mine, allow people to start soft foods (if the full liquid diet was ok the day before) on Day 3 post-op with no problems whatsoever.

Lora

I think you have it right......

BAD procedure: 
> don't chew well
>drink right away
>force big chunks through stoma (exit of pouch)
>do this often enough, you stretch the stoma wide = broken WLS

GOOD procedure:
>chew REALLY well
>DON'T drink with meals
>Allow the food to process before drinking (half hour)
>Follow this procedure, and you're likely to have satiation for a good chunk of time, and successful weight loss.

I was on full liquids for three weeks postop adn purees for five weeks postop.

You have been a great help!  I had requested the guidlines my doctor follows and just got them.

First few days, obviously, clear
1-2 weeks of liquidly blenderized foods
3-6 weeks of puree/blenderized
after 6 weeks gradual reintroduction of soft foods
after 6 months 3 small balanced meals....NO MORE SNACKS!!

So this is kind of like yours.  I know with my sleeve I was sure I was never going to eat again and may have rushed it but now I know better and what is, even 6 weeks, of blenderized food out of the rest of my life?  Nothing!  Anything to get rid of the diabetes!!

I will be so careful now with the stoma.  I never realized it is one of the most important thing to take care of if not the most!!

Thanks so much!  You are a wealth of knowledge!  I'm getting excited now.  I've been a basket case over this again but when I know what I'm dealing with I'm much better.