Raze
About My Surgery
Dec 31, 2014
Hello All
Well my posting on the board tends to be long, so you can imagine my blog. But perhaps something I share will be useful to some or one. It seems to pre-ops and post -ops alike the type of surgery had is of some interest, and visiting the board just recently for the first time in forever has caused me to think about my own.
I had the Fobi Pouch procedure completed almost eight years ago and am maintaining a 240 pound weight loss. Pretty darn good and about what I had hoped for going in. I did not choose this surgery so much as it chose me. Let's just say opportunity knocked, I got informed of the procedure, and went with it. I am not an advocate for the procedure or a fan of it in particular. We all choose our own surgery and path. It has been greatly effective for me concerning weight loss and even almost eight years out is significantly restrictive regarding the amount of certain foods I can eat. I consider it a great success in my case being the tremendous weight loss, zero complications, and no maintenance nutritional routine I follow. However I know that has something to do with the procedure and also a lot to do with me. So far, so good.
That said it is a typical RNY for all intent and purposes. The Fobi simply sews the pouch instead of stapling, and puts thin silastic places a thin silastic ring around the stoma to enhance restriction. It is not a too common procedure to this day as it takes more time to complete on the operating table making it costlier, and many doctors simply consider it unorthodox or unnecessary. Dr. Fobi liked to consider it an improved RNY, and I do believe he was one of the first surgeons to "detach" part of the stomach and develop a pouch in WLS rather then simply stapling a section off, making a smaller stomach. Which led to all kinds of complications considering staple line breakdown in "old fashioned" WLS days.
However if you read my posts on the board and see my pics in my profile do not take that as advocacy for this surgery. Indeed I would carefully consider having this surgery as Dr Fobi is now retired as are many of the doctors he trained and mentored in performing this procedure. I do not consider it riskier and indeed some of its potential complications such as ring erosion over the years are imo overstated and over emphasized as dangers. Statistics bear this out, and even in cases of ring erosion that is all there is to it, usually. The ring is simply gone with the stoma fixed in place. And a "new" ring has been used in recent years to help prevent this. Otherwise from pouch on down this is a typical RNY but for the sewing instead of stapling. But somewhat more restrictive RNY.
I am writing this blog post not to encourage people to the Fobi, but to actually have them turn away from it if not comfortable with the idea. I see posts in the Fobi Pouch forum both pro and con, but many con. Which is to be expected of any WLS type on WLS forums. Botched surgeries, "failed" surgeries, people with regrets and complaints of all things, about not being able to tolerate or eat certain foods. Of the Fobi one patient some years out and with good results now has complaints of not being able to tolerate eating meat, and throwing up. To which I think "they should have told you about that going in." That can be typical of the Fobi pouch, as it is highly restrictive. So know what you are signing up for and be prepared to roll with the changes whatever surgery you have. And know this...if you have not had surgery yet you will read pro, con, and folks screaming and complaining to high heaven all over WLS message boards about this, that, and the other. Some are frivolous, others legit, and many are highly subjective. For instance I cannot eat a steak or chicken breast. I don't care. Others might to a great degree and blame their surgery. Yet other more unfortunate patients will suffer greatly with medical complications, illness, and near death trauma. This can happen for a number of reasons but many blame the surgery type when in fact it's just having any weight loss surgery. Outside a completely botched procedure not all will respond the same to the same procedure and some will have a very hard go of it. To those I truly have compassion for, and commend them for there courage.
Which brings me back to the Fobi Pouch. For those considering WLS and if offered or recommended, I would say be quite wary of the Fobi as even the center where Dr Fobi performed thousands of the operations does not favor them. Some of that is cost, but it's also because Dr Fobi is retired and no longer there to supervise or mentor. Other WLS have come along since RNY, and those must be looked at, too. And while the Fobi is excellent for weight loss so are other procedures more commonly performed these days. IMO it is a somewhat specialized RNY and should not be performed by someone with little or no knowledge of exactly how to do it. I have read some offer it as a "Fobi" but use staples on the pouch, as well as overlooking other aspects Fobi included. In short simply tying a silastic ring around the stoma is not a Fobi Pouch. It is a variation, but a somewhat crude one.
Below are the specific characteristics of the Fobi Pouch. If you are offered this surgery and these specifics are not in place be wary imo and know it is not the Fobi as Dr Fobi himself intended, suggested, or performed
1)Vertical 30 cc pouch - Easy to intubate, less distensible, provides early satiety.
2) Transected Pouch - Minimal mobilization, no problem with staple line breakdown, minimal occurrence of marginal ulcers
3) Banded pouch, longer band, 5.5 - 6.5 cm - Leaves a large stoma but limited in diameter, allows dumping but not severe dumping
4) Imbricated Gastrojejunostomy - The limb of the jejumun that is brought up to form the gastroenterostomy is also used to imbricate the transected edge of the proximal pouch thus diminishing the possibility of leaks and subphrenic abscess.
5) Large gastroenterostomy 1.5 - 2 cm long - Markedly decreased rate of gastric outlet stenosis
6) Decompressed distal gastric pouch with a gastrostomy - No incidence of acute gastric distension, decreased incidence of atelectasis, provides for temporary feeding and administration of medication if the need does arise.
7) Marked gastrostomy site - Provides easy access to study distal bypassed stomach radiologically and/or endoscopically, as needed, access for enteral feeding in the rare case of excessive weight loss.
