TRANSECTED SILASTIC RING VERTICAL GASTRIC BYPASS WITH JEJUNAL

INTERPOSITION, A GASTROSTOMY AND A GASTROSTOMY SITE MARKER

(Fobi Pouch Gastric Bypass OPERATION FOR OBESITY)

Mathias A.L. Fobi, Hoil Lee, Daniel lgwe, Basil Felahy, Malgorzata Stanczyk and Julius Tambi

The vertically transacted silastic ring banded gastric bypass is a modified gastric bypass operation for obesity. This operation plus a temporary gastrostomy tube and a gastrostomy site marker compose the Fobi Pouch Gastric Bypass Operation for Obesity. The silastic ring band provides the external support and calibration that is necessary for long-term weight loss and maintenance. Transacting the stomach instead of stapling in-continuity when forming the pouch decreases the incidence of gastro-gastric fistula formation. The interposed jejunal limb decreases the incidence of bleeding and leaks due to transacting the stomach and thus the incidence of Intra-abdominal abscess. The routine use of the temporary gastrostomy tube to decompress the bypassed segment decreases the incidence of acute gastric dilatation with the inherent risk of perforation. This temporary gastrostomy tube also provides a route for nutritional support if needed In the immediate postoperative period. The marker at the gastrostomy site provides for ready access to the bypassed stomach; this enables diagnostic and therapeutic access to the bypassed segment after gastric bypass operations. The transacted silastic ring vertical gastric bypass can be modified to a vertical transacted silastic ring distal Roux-Y gastric bypass to maximize weight loss if necessary. The operation is reversible if the need does arise. Patients who have this operation must take nutrient supplements and be monitored lifelong.

Obesity is a disease.¹ The exact etiology is not known. Scientific data presently available is highly suggestive of a genetic predisposition. Social, economic and psychological factors are necessary for the expression of this disease ³ This disease ranges from mild to malignant obesity. Obesity, particularly morbid obesity, is a chronic ailment that has been recalcitrant to non-surgical medical treatment ⁴ Surgery remains the only viable option for long term control of this disease at this times Surgical intervention for obesity started with the malabsorptive operation; jejuno-ileal bypass (JIB).^6,7 This operation has been abandoned because there are other equally effective operations now available that have less morbidity and mortality. Gastric bypass (GBP) procedures for obesity are considered the gold-standard for surgical