In order to minimize the chance of staple line leak, right after surgery the patient is on liquids and progressively soft foods for a month. If the patient eats solid food too early there can be some incresed risk of staple line leak.  After about 6 to 8 weeks after surgery there are very few concerns about staple line leak. Note that with gastric bypass and the gastric sleeve resection is that with proper eating habits, hunger is curbed, not alleviated. Understanding the anatomy and the mechanics of the way the pouch works and eating with certain concepts and strategies is absolutely necessary for success. The anatomy of the pouch and working successfully with good strategies of eating are what are going to produce and maintain long term weight loss.

- How to be successful with a gastric bypass or gastric sleeve resection:

(Click here for a copy of How to be Successful with gastric sleeve resection or gastric bypass)

Dr Fermelia's tips on understanding and success with the pouch.

Stretch receptors.  Understand that the gastric pouch works because it creates a small (approximately 4oz.) stomach pouch above the band.  Stretch receptors in the pouch to tell the brain that you are full.   Gastric distention creates a neural and hormonal signal to the brain of satiety (satisfaction, the opposite of hunger). 

The pace of eating.  This communication between the brain and the stomach takes several minutes, so we counsel patients to eat slowly (more than 15 minutes) and they will eat less.  The slow pace of eating is important.

Solid food.  The most important idea is to eat solid, dense food.  This is what will stimulate the stretch receptors in the pouch and help you to feel full with a small amount of food.  If you eat mushy or liquid calories, they will go quickly into the lower stomach and you will not feel full for long.  Pressure in the pouch over time is what stimulates the stretch receptors.  Studies show that is the pressure in the stomach wall of the pouch that creates the sense of fullness.  Dense food stays in the pouch.  Everything you eat should be solid and dense.  Mushy foods are called “slider foods” because they slide right out of the pouch.  You will feel unsatisfied all day.  You will be hungry all the time.

Protein.  Protein is the best food while losing or maintaining weight loss.  Fat has about twice the calories per gram compared to protein and carbohydrates.  Protein intake is going to minimize the loss of lean body mass (muscle) during the weight loss you will experience.  Choose low fat proteins.  Have protein with every meal.  Eat protein first.  Fill up on protein.  Eat your entire protein portion completely before moving to other foods.  Most people are overweight because they eat too many carbohydrates: simple sugars (sweets) or starches (bread, pasta, potatoes, etc.).  The pouch will not let you overeat carbohydrates.

Eat only 3 times a day.  If you follow these ideas and have a proper band adjustment you will feel satisfied between meals.  Our philosophy is that you should not just eat “when you are hungry”.  If you eat regularly you will not feel deprived and you will not get over hungry and throw all these ideas away.  “No calories between meals” should be your policy. 

The sequence of eating.  Eat dense low fat protein with every meal.  Every meal, including breakfast.  Then eat vegetables and fruits.  Then and only then, eat carbohydrates.  The order of the food you eat is important.

Don’t wash out your pouch.  We need pouch distention pressure over time to help you to feel full.  You want to feel full for hours, until your next meal.  Don’t drink with your meals.  If you drink with your meals it is like eating mushy food.  The food will move out of the pouch and you will soon be hungry.  If you drink right after your meals you will wash the food out of the pouch and you will soon be hungry.  We recommend waiting 30 to 60 minutes after meals.  Between meals you should drink large quantities of NON calorie beverages.

Healthy food.  You know what you should be eating.  Since you are not going to get a lot of calories, they have to give you all the nutrients you need.  Plan your meals.  Have good choices available.  If you are eating on the run, you are going to make bad choices.  Don’t settle on eating the “healthiest thing” you can find at the fast food restaurant. Eating right for a lifetime is an effort, but your lifelong success is worth it.

Rules to Live by:

1. Eat only three meals a day. 
2. Do not snack or “graze” between meals. A good rule:  NO CALORIES BETWEEN MEALS
3. Eat only solid food.  Avoid soft, mushy, or liquid foods.
4. Each meal should be low in fat and contain protein.
5. Eat protein first followed by fruits and vegetables. Fill up on protein, you should eat very few simple or complex carbohydrates.
6. Eat slowly. A meal should be eaten in 20 to 30 minutes.
7. Eat only nutritious food. Plan your meals and don't eat on the run.  Take healthy food with you.
8. Stop eating when you feel satisfied (slightly full).
9. Limit fats, sweets, alcohol and carbohydrates.
10. Do not drink anything during, or 30 to 60 minutes after a meal.
11. Do not drink liquid calories in any form.
12. Exercise for at least 30 minutes each day emphasizing muscle-building resistance training.

Click here for a copy of Rules to Live by.