The stoma is the opening from your pouch to your intestines.  This opening is what permits food to pass through. If it is too large you will not have any restriction no matter how small your pouch is. The food you eat will travel freely into your small intestines. The bypass works by offering you both restriction and malabsorption so a large stoma will jeopardize your weight loss because it will not give you any restriction. The ideal opening of the stoma is under 18 mm. 


A barium swallow x-ray or endoscopy will let your surgeon know the size of your pouch and stoma.   He needs the pouch to be large enough so he can work on it. If it is a good size he can redo your pouch and make the stoma smaller at the same time. This is the best option.

If the pouch is not large enough ( smaller than 5 cm in height)  the stoma may be plicated to give you some restriction. This is a temporary solution though which will only help you initially since the sutures may come undone or the stoma may stretch again fairly quickly. This last option is only offered when the surgeon will be adding malabsorption too as it will not work very well on its own. 


The gastric bypass has the advantage of allowing patients to lose weight in two ways.  The restrictive component plus the malabsorptive component, losing weight the first few years is easy even if you are not very careful in choosing what you eat given the nature of the bypass.  But over time if habits aren’t changed weight can creep back up. 

We recommend patients change eating habits right after surgery. It will not only maximize your weight loss results from the beginning but will let you create good habits that will last a lifetime. 


 Go back to working with your bypass. The surgery is still there to help you. Protein is key with all weight loss surgeries so be sure you have protein in every meal and snack you eat. Continue to keep meals separate from drinks as well, this is a rule that many patients forget over time and avoid high-calorie liquids. Visit a bariatric nutritionist if possible, certain food combinations work best for weight loss and keeping you satiated throughout the day to better help you change your habits. 


The malabsorptive component of the bypass is just as important as the restriction.     The length of the limbs your surgeon leaves during surgery determines how much malabsorption you will have after surgery. There is no one size fits all solution, your surgeon will determine the lengths once he is inside and measures the total length of your intestines and takes into consideration other factors like your BMI, comorbidities you may have, the size your pouch, etc.

For some patients, the malabsorption they have is not enough to help them keep the weight off long term. As time goes by the body becomes more efficient and learns to absorb more so patients lose more of the malabsorptive component and are solely relying on the restriction the bypass offers and this may not be enough to maintain weight loss.  Some patients may need more malabsorption added in the long run. 


Your surgeon may add malabsorption to your bypass regardless of whether the pouch and stoma need to be redone too.  The amount of malabsorption that may be added will depend on what measurements your surgeon used in your original surgery. Having our original surgery report is helpful but your surgeon will measure the limbs once inside to determine what will be done to help you absorb less. 


There is not one single technique for performing a gastric bypass. Surgeons use their criteria, experience, etc. to determine how the bypass will be done. This means that some surgeons give patients different size pouches. Having a pouch that is too large for you means you are able to eat too much food in one meal. Restriction is one of the 2 components of a bypass and a  very large pouch eliminates this important aspect. Initially, you may lose weight fine but over time if the pouch is too big you will most likely regain the weight. 


Your surgeon may perform a barium swallow x-ray or endoscopy to check the size of your pouch to see if it can be made smaller.  If you have the information ( surgery report) of what was done during your surgery the surgeon can determine what may be done. Redoing your pouch automatically means they will redo your stoma too so you will have a lot of restriction. 

If your pouch is large but not large enough that it may be fully redone, your surgeon may plicate from the outside it to give you some restriction.  This is only done when patients will be adding malabsorption too since this is only temporary help.