"Can I ever lose too much weight?"

With the possible exception of the rare patient who develops obstruction of the stomach outlet, it is unlikely you will ever lose too much weight. On  the other hand, snacking and high calorie liquids can put on weight readily.

"Will my skin sag?

Because of the large amount of fat between the skin and the true body, the skin will surely sag as fat is removed by the slow gradual burning of energy in everyday life. Since the weight loss is rapid in the first six months, the skin cannot keep up the pace and, indeed does sag. During this period however, elasticity of the skin is improving and the skin is also shrinking. This process will continue over the next one or two years and your appearance will be worse at about six months, although it will improve gradually thereafter. Regular and progressive exercise will also help the appearance of the sagged skin. The skin of younger bypass surgery patients recovers more rapidly than others.

"Should I eat more and avoid the rapid weight loss in order to prevent sag?

No. definitely not! The sag is related to the total amount of weight loss. It only appears worse during the rapid weight loss phase. If anything is done to slow down weight loss in the initial three to nine months, the opportunity for easy weight loss while the pouch is very small will be lost forever.

"What happens to the unused part of the stomach?"

It remains in place and its ability to function remains intact. The muscles may loose some of their contractile power but each cell is still there and capable of functioning in the unlikely event it should be called upon.

"Can the stomach be hooked up again?"

It is possible, but doing so would result in regaining most or all of the lost weight. We have never been asked to reverse the operation.

"What is dumping?"

Dumping is the word describing the fact liquids and sweets very rapidly empty out of the stomach into the jejunum through the small pouch. Sweets have a characteristic called 'hyperosmolality' which means it has a high concentration of particles in solution. One of the functions of a normal stomach is to act as a reservoir where food will be held until the concentration of particles are "dumped" from the small pouch into the digestion/absorption part of the gastrointestinal tract, the jejunum. The jejunum reacts by sending off chemical signals to stop the intake of such materials on such a rapid basis. These chemical signals cause nausea, dizziness, and faintness - an awful feeling. The chemical signals are relatively harmless but they should not be repeated in order to avoid these unpleasant symptoms.  This might be a bad thing if one continued to crave sweets, but most sweets lovers will come to loathe sweets after this symptom occurs a few times.  The  avoidance of sweets under these circumstances is called an "aversion reaction", and may account for a significant part of the weight loss results.

"Why do some suffer more gas or diarrhea than others?"

Most gas is simply the 80% of swallowed air which is nitrogen, the oxygen part of all being absorbed. Some people more than others tend to be air swallowers and swallow air during eating, talking, etc. Nitrogen, which constitutes 80% of the air swallowed, must go all the way through the intestinal tract to the rectum. Others may have the "irritable bowel syndrome" in which, because of anxiety, the colon becomes irritated, causing cramps, with, at times, alternating constipation and diarrhea.  These symptoms can be reduced by the use of bran or other stool softeners to keep the stools quite soft and the work of the colon to a minimum.  The trnquilizing effect of aerobic exercise also benefits the irritated bowel.

"May I have my pouch made smaller if it grows too much, and what is involved?"

It can be made smaller by another operation which is more difficult and dangerous than the first because of the degree of scarring around the stomach due to the previous surgery.

"How do you know how large the pouch has grown to?"

The size of the pouch after surgery is the most difficult parameter to measure. An upper GI series, endoscopy (looking at the stomach directly through a tube), and other tests have not been of much help.

"Is there a chance to regain weight?"

Some patients may come to feel frustrated and discouraged after weight levels off but is yet too high, or when slow weight regain occurs. This cannot go uncorrected.  While responsibility to continue making progress and to avoid regression remains with the patient, help will be available. It is important to constantly realize that the pouch is there only as a tool and must be used property. If this leveling off of regression happens, support may be necessary and it is, important to come back to see us so we may evaluate your case. We will then go back into your history and review the things you have learned in your first evaluation and the booklet.  Re-evaluation does not mean either the operation or you have failed. We are aware it often requires considerable time and effort to change the habits of a lifetime predicament.          We want to be viewed not as critic but as coach and friend.  In our evaluations as we go along, we will consider such things as pouch size, outlet size, staple line. integrity, the rate of stomach emptying, etc, We may find the pouch does not function as it should at that stage of your recovery. We have found with some patients the pouch (just a tool, remember) functions adequately but the patient should return to his basic understandings and revised lifestyle. Whatever the cause of regression or lack of progress, please seek support or an evaluation, there is no need to feel embarrassed.

"What is your advice to me?"

As you go on with your life, losing weight and feeling better day by day, keep in mind the gastric bypass operation is not a miracle cure for obesity .. don't be impatient.  It is certainly not an easy "out." Gastric bypass is major surgery which requires a lot of effort, dedication, and cooperation from the patient. You will not have had this operation unless you fully understood all the problems and changes which can arise and were willing to accept the risks. You were willing to cooperate fully in follow-up treatment. You recognized the best results are obtained when patients follow through with proper dietary and exercise habits and careful follow-up. There are many changes and adjustments to be made and it is possible to experience some frustrations along the way, but the pride and feeling of accomplishment you will feel as you lose weight  weight will be worth it. We are convinced you can and will demonstrate the required dedication, even though you may need a helping hand now and then.