with Dr. Kelvin Higa
Weight regain or inadequate weight loss after gastric bypass represents one of the most challenging problems in revisional bariatric surgery. Pouch and/or stoma reduction has little to offer, except for short-term and minimal results. Operative revision of the gastric pouch is associated with 3-5 times the incidence of leak and other post-operative complications. Separating behavioral and biologic causes for weight regain is difficult and there are no biochemical measurements available to assist in this important differentiation. A subjective, but consistent tool uses the symptoms of the disease, i.e., hunger and satiation as a surrogate for biological food and calorie acquisition as opposed to psychologic eating. Therefore, taking advantage of the increased metabolic response of the distal type 1 bypass can provide a better response and safer revision than working on the pouch.
Clinical Background
38-year-old man
150.1 kg, 173 cm, BMI 50.2
Current problem: weight regain
Technique Description
2010: Lap RNY gastric bypass
Other: 2007 Abdominoplasty + liposuction
Co-morbidity: hypertension, dyspnea, knee pain
Medication: Multivit
Lab: Folic Acid 1.9 µg/L, tot chol 236mg/dL, TG 233mg/dL, LDL 138mg/dL, HDL 51mg/dL, Vit D 18.2 µg/L
Daily calory intake: 796 kcal/d (?)
Gastroscopy: NI status post RNY
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