Weight regain after gastric by-passAss Pr Jean BIAGINI

Weight regain after gastric by-passAt 10 yrs failure rate (BMI > 35) 20% for

MO and 35% for SO, limb length doesn't impact long term weight loss. Ann Surg 2006, Christou et al.

Weight regain (>8% WL) is 50% at 24 months mainly in super obese. Metabolic & hormonal mechanisms? Obes Surgery 2008 Magro et al.

Hyperphagia is the major cause of weight regain, Lap placement of of non adjustable Silicone Ring. Obes Surg 2009, dapri et al

Weight regain after gastric by-passPersonnal experience16 cases, Barium UGI study role3 Adjustable gastric band, 1good result, 2

moderate1 case gastric pouch reduction, moderate

result1 case alimentary limb lengthening, bad result2 cases Gastrectomy for gastro-gastric fistula1 case of jejunal limb diameter reduction8 cases non-adjustable silicone band

Weight regain after gastric by-passPersonal experience, gastric dilation

Weight regain after gastric by-passPersonal experience, gastro-gastric fistula

Weight regain after gastric by-passPersonal experience, jejunal dilation

Weight regain after gastric by-passPersonal experience, anastomotic & jejunal diam reduction

Weight regain after gastric by-passPersonal experience, normal UGI

Weight regain after gastric by-passPersonal experience, Home made “Fobi ring”

Weight regain after gastric by-passPersonal experience, ring on the anastomosis

Weight regain after gastric by-passPersonal experience, Weight regain

Weight regain after gastric by-passPersonal experience, after band

Weight regain after gastric by-passNH, band failure

Weight regain after gastric by-passNH, mini GBP

Weight regain after gastric by-passNH, weight regain, jejunal dilation>> 7cm fixed band

Weight regain after gastric by-passNon adjustable band experience

8 cases with normal gastric pouch.Band: 5.6cm-8cm, usually 7 or 7.5cm.36 fr calibrating tube.6 laparoscopic, 2 open.Weight reduction: 6-25kgs.

Weight regain after gastric by-passConclusionsImportance of Barium UGI study to detect

and repair an anatomical cause (big pouch, wide anastomosis, gastro-gastric fistula etc)

If acceptable anatomy>> Non Adjustable silicone band.

Alternative: Stomafix, jejuno-anastomo-gastric pouch sleeve or plication.