The fobi pouch is one of the latest additions to the growing list of bariatric surgical procedures. It is not an entirely new procedure but rather a modification of an old procedure. The fobi pouch operation or rather this modification was first described by Mathias Fobi MD, FACS.
His inspiration was triggered by the failure of the regular gastric bypass surgical procedure when weight is regained in the long term after an initial short to medium term weight loss.
Dr Fobi believes that obesity is a condition that is not easily cured, so dealing with it requires a long term solution as opposed to weight loss surgical procedures that don’t last the marathon.
What is the fobi pouch?
The fobi pouch is a small pouch created from the lesser curve of the stomach and this pouch is usually the size of about 30cc – 50cc. Previous gastric bypass surgery meant the stomach was stapled between the new pouch and the rest of the redundant stomach.
Over time, the staples gave way and there was re-connection between the created pouch and redundant stomach. This led to weight regain.
Now, the fobi pouch surgery separates the new pouch from the rest of the redundant lower stomach eliminating that problem of re-connection.
How else does the fobi pouch differ from the roux en y gastric bypass surgery?
Apart from separating the new pouch from the lower stomach, the fobi surgery also differs from the roux en y gastric surgery in another way. How?
The opening between the small pouch and the small bowel has a silastic ring put around it to stop it from stretching. This controls the food leaving the small pouch into the small intestine and more importantly, prevents long term slackness of this opening.
Apart from those differences, the fobi procedure follows the same structure distally as the usual roux en y gastric bypass surgery procedure.
The net effect is that the weight lost is kept off for good.
How much weight can you expect to lose with the fobi pouch?
This is where the fobi pouch beats the regular gastric bypass – the success rate.
The success rate of the fobi pouch is excess weight loss of well over 90% even after 5 years compared to the 75% excess weight loss success rate of the roux en y bypass.
So if your ideal weight is supposed to be about 190 lbs and you weigh 330 lbs, then excess weight is 140 lbs i.e 330-190=140.
Following fobi pouch surgery, you can expect to lose 126 lbs which is 90% of your excess 140 lbs. Research has shown this weight can be kept off well beyond 5 years – much lower failure rate.
How does the fobi pouch surgery work?
This procedure has both a restrictive and a malabsorptive aspect. Restrictive because the small pouch can only accommodate very small quantities of food at a time meaning less calories consumed.
Malabsorptive in the sense it is a bypass procedure which means some of the intestinal areas where food is absorbed is bypassed. The implication of this is that, less calories are absorbed. Weight is lost over time as a result.
What are the complications and risks of fobi pouch?
- As with most bariatric surgical procedures, there are risks. Firstly, the fobi pouch takes a longer time to complete.
- Bleeding can occur, hopefully not severe enough to warrant blood transfusion.
- Wound infection which should respond to antibiotics.
- Heart burn
- Nausea and vomiting especially if food is not chewed properly
- Anaesthetic complications like allergy to anaesthetic medications
- Venous blood clots can form in the legs and in the lungs but quick mobilisation after surgery after surgery and blood thinning injections can reduce the risk of this.
- Nutritional deficiencies can occur because by its very nature, fobi pouch has a malabsorptive component. Deficiencies like Iron Vitamin B12, Calcium, Vitamin D, Folic acid. These are preventable though.
How are the nutritional deficiencies prevented in fobi pouch surgery procedure?
As stated above, malabsorption results in these deficiencies. The easiest way to deal with them is to take nutritional supplements in the form of tablets, injections or nasal spray. You will need your doctor to prescribe these for you.
What kind of diet can I expect after fobi pouch bypass surgery?
You will learn to adapt to a new way of eating ultimately after the surgery. Soon after the operation, your initial diet will be liquid type for the first couple of days to allow for the new pouch to small intestine connection to heal.
You will then progress to semi-solid diet which you will maintain for about 4 weeks or thereabout. You will need to learn at this point that the size of the stomach pouch is such that it cannot accommodate both food and drinks at the same time.
So you will need to drink in between meals and this is important to avoid dehydration.
Once your bariatric doctor and dietitian are happy with your progress, solid food will be introduced.
You will need to understand at this juncture that the solid food you eat would need to chewed thoroughly before swallowing to prevent indigestion and vomiting.
Your situation will be monitored closely to ensure your progress is sustained and your solid diet requirements are stabilized as this is essentially a life-long project. Welcome to the new you courtesy of the fobi pouch!