fobi pouch: stay away
In case anyone has been offered a fobi pouch as an alternative to the RNY, I want to explain how this surgery was invented and why I hope noone else gets this procedure. If you are not preop gastric bypass, then reading this will probably be a waste of time:-)
First of all the fobi pouch is a variation of the RNY gastric bypass. The RNY has acceptable weight loss and is considered standard procedure with wls. One of the problems that is fairly common in RNY patients (sorry I don't know percents) is having a dilated stoma, which leads to lack of restriction and regain. There are many revision procedures, such as the rose procedure that are meant to correct this type of complication.
Being that the RNY has fairly good weight loss results DR. fobi wanted to figure out how to prevent the stoma from ever becoming dilated. By preventing the stoma from dilating, Fobi hoped it would lower the number of patients that will require a revision. So, Fobi figured that if he put a band (known as a fobi ring) around the stoma it would prevent it from becoming dilated. The problem with this is that the surface area of the RNY pouch is not big enough to do this. To make the pouch have greater surface area (to place the band), fobi bypasses a greater portion of the stomach and makes a longer pouch than a RNY.
RNY
Fobi pouch
Now it turns out that Fobi's variation did what was intended. By adding the band, he reduced the revision percentages of the RNY from about 20% (in first 5 years) to about 5% with his variation. The problem is that this comes at the expense of more complications.
Due to cutting more of the stomach to make a pouch that can have a band placed, there are much more active cells that are cut off by the blood supply of the lesser curvature of the stomach (sorry I can't find good diagram to show this). Consequently, fobi pouch patients are at a much higher risk of having serious complications of strictures, severe vomitting and acid reflux than a RNY patient.
Since my surgery on 10/28/09, I have had 2 balloon dilations to repair strictures. Both occured within 3 months post op. During those few much I had sever vommiting all day, and everyday. Since then the vomitting has been on and off, but it has gotten much worse in the last few month, as well as the frequency of acid reflux. These complications are seriously horrible, and I can honestly say that a more restrictive pouch is just not damn worth it. I would much rather be at a higher risk for a dilated stoma (which isn't necesarily the end of the world if you can manage it), then having these nasty episodes of vommiting and reflux.
Conclusion: I would advise against this procedure as an alternative to the RNY. It is quite ironic that I am needing revision tdue to fobi's "grand" idea to prevent the need for revision. Oh well... If you have any questions feel free to ask.
First of all the fobi pouch is a variation of the RNY gastric bypass. The RNY has acceptable weight loss and is considered standard procedure with wls. One of the problems that is fairly common in RNY patients (sorry I don't know percents) is having a dilated stoma, which leads to lack of restriction and regain. There are many revision procedures, such as the rose procedure that are meant to correct this type of complication.
Being that the RNY has fairly good weight loss results DR. fobi wanted to figure out how to prevent the stoma from ever becoming dilated. By preventing the stoma from dilating, Fobi hoped it would lower the number of patients that will require a revision. So, Fobi figured that if he put a band (known as a fobi ring) around the stoma it would prevent it from becoming dilated. The problem with this is that the surface area of the RNY pouch is not big enough to do this. To make the pouch have greater surface area (to place the band), fobi bypasses a greater portion of the stomach and makes a longer pouch than a RNY.
RNY
Fobi pouch
Now it turns out that Fobi's variation did what was intended. By adding the band, he reduced the revision percentages of the RNY from about 20% (in first 5 years) to about 5% with his variation. The problem is that this comes at the expense of more complications.
Due to cutting more of the stomach to make a pouch that can have a band placed, there are much more active cells that are cut off by the blood supply of the lesser curvature of the stomach (sorry I can't find good diagram to show this). Consequently, fobi pouch patients are at a much higher risk of having serious complications of strictures, severe vomitting and acid reflux than a RNY patient.
Since my surgery on 10/28/09, I have had 2 balloon dilations to repair strictures. Both occured within 3 months post op. During those few much I had sever vommiting all day, and everyday. Since then the vomitting has been on and off, but it has gotten much worse in the last few month, as well as the frequency of acid reflux. These complications are seriously horrible, and I can honestly say that a more restrictive pouch is just not damn worth it. I would much rather be at a higher risk for a dilated stoma (which isn't necesarily the end of the world if you can manage it), then having these nasty episodes of vommiting and reflux.
Conclusion: I would advise against this procedure as an alternative to the RNY. It is quite ironic that I am needing revision tdue to fobi's "grand" idea to prevent the need for revision. Oh well... If you have any questions feel free to ask.
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