Fobi Pouch Roux-En-Y Gastric Bypass

Fobi Pouch Gastric Bypass Surgery

Gastric bypass has long been regarded as the “Gold Standard” bariatric operation for achieving reliable weight loss. There are however many different variants of gastric bypass and some are more reliable than others in terms of long-term weight loss. The Fobi Pouch gastric bypass, which is a particular form of “banded gastric bypass” is available in NZ as an open operation, which is seen by many as a disadvantage. However, the published results of this operation and other forms of “banded gastric bypasses” undertaken around the world, show this variant of gastric bypass to be the most reliable of all bypasses in the long term. (refs)

The particular features of the Fobi Pouch that make it so reliable are as follows:

1) The long, narrow pouch – this ensures there is very little prospect of enlargement of the pouch over the years. Most other forms of gastric bypass entail creation of a small, shorter and wider pouch, which can dilate more easily (compare the ease of blowing up a small round balloon and a long thin balloon)

2) The silastic ring – this ensures the size of the outlet of the pouch never changes over time. Without this ring, the join that was made at the time of surgery enlarges over time and allows more food to be eaten.

3) The reinforcement of the staple line – with this bypass a section of the small intestine is sutured over the staple line of the pouch as a patch. This virtually eliminates the possibility of the two parts of the stomach joining up again, with s so-called gastro-gastric fistula formation, which can result in weight regain and ulceration.

These features ensure that the degree of restriction imposed on eating in the first 1-2 years, remains permanently. In other forms of gastric bypass, this is not always achieved and weight regain after 2-4 years can begin. The Fobi Pouch operation is the least likely of all bariatric operations performed in NZ to ever need to be redone, because of weight regain.

References:

Mahawar KK et al, Obes Surg, 2014 24: 1771-1792

Buchwald H et al, Obes Surg. 2014 24(9):1536-51.

O’Brien PE et al,   Obes Surg. 2006 16(8):1032-40.

Stubbs RS and Sarvepalli R, World J of Surg Proced 2014;4(2): 48-54