Dr. Mathias Fobi discusses how surgeons help their patients choose which bariatric procedure they need.
Weight loss surgery comes at five different weight loss operations right now that are popular in the United States. The standard gastric bypass, we call it standard because it is the one that’s been used for a long time. It was first described in 1967, and has been used for a long time.
Then the Fobi pouch, which is a modification of the gastric bypass. Recently we do a procedure called a banding procedure like the LAP-BAND® and the REALIZE® band and in there’s the sleeve gastrectomy, which is where they just remove part of your stomach and leave a small tube, which works as a stomach and restricts how much you can eat. Then there’s another procedure, which is called a biliopancreatic diversion which is a little bit more complicated.
How do you decide who should get what operation? It’s informed consents. We inform the patient about the various procedures. These procedures have different success rate. What is interesting is that the more successful the surgery is, the more the maintenance. The more there might be complications and there’s need for more follow up, like the biliopancreatic diversion is the best operation in terms of weight loss, but also it has complications of malabsorption that can occur.
So you do not recommend this to just anybody. It has to be somebody who is knowledgeable enough to understand the medical complications that can occur and would come for regular check every three months. That operation is rarely done in the United States. It’s most popular in Europe because people in Europe are sedentary. They stay in the same community for most of their lives.
In the United States, people move like every two or three years and if you lose a patient to follow up, the patient might go somewhere and get complications and never have anybody to do it. So most of us in the United States don’t do the biliopancreatic diversion.
The gastric bypass is the most common procedure that is done. It is effective. It can be done on everybody and is good for the overweight, the person that is barely overweight, the person who is extremely overweight. The Fobi pouch again, is the gastric bypass with that modification and is good for everybody. So it is good for the person that is barely qualifying for surgery and the are real big person and the man and the woman. Then you have, like, the LAP-BAND®.
The LAP-BAND® is the simplest, safest procedure, but that procedure works good only for people who are barely overweight. Those are people with a low BMI, with BMI of 35 to above 45 because the weight loss with a LAP-BAND® is not as good as with the gastric bypass. So if you have somebody who is about 200-250 pounds, a LAP-BAND® is a good operation because if they lose 60 to 70 pounds they do well. But if you take somebody who is 300 pounds and above and give them the LAP-BAND® and they lose only 60 pounds, they are still overweight.
So generally the bigger the person is, the more complicated procedure you want to give them and the less of a weight the person is, the less complicated procedure. It also depends on the wishes of the patients. After I have described the procedure, the outcome, and the complications, the patient will make a choice as to what they want. They are the ones that have to live with the surgery. It is very important to understand that surgery is not a cure. Surgery is a tool we give the patient to use. Any of these operations can be very successful or can fail, depending on how the patient does use it.
There are some tools which are more efficient than all this. But again, ultimately it is the patient; how they use that tool that determines how effective that procedure is. So, in this operation when we see people we’d recommend that they have the procedure that has the highest success rate, which is either a Fobi pouch or the gastric bypass, but if a patient is knowledgeable enough, can follow the instructions, can come back for regular follow up and is not severely overweight, that means they are less than 250 pounds, then we will recommend the LAP-BAND® for them and these patients will do well with the LAP-BAND®.
Dr. Mathias A.L. Fobi, M.D., F.A.C.S.:
Dr. Mathias A.L. Fobi, is an internationally recognized bariatric surgeon, who has changed the shape of Hollywood heavyweights such as Etta James and American Idol’s Randy Jackson. MAL, as he is known among friends, was born in Nkwen, a small village in Cameroon, West Africa. He is a member of the first batch, class of 1965, 0f Sacred Heart College in Mankon Bamenda in Cameroon. He came to the USA through the African Scholarship Program for American Universities (ASPAU) in 1966. This was a scholarship program that was inaugurated by President Kennedy along with the Peace Corps Program.
Condition: Obesity, Morbid Obesity, Weight Loss, Morbidly Obese
Related Terms: StomaphyX™, Weight Loss, Bariatric Surgery, LAP-BAND®, Laparoscopic Gastric Banding, Gastric Sleeve, Revisional Bariatric Surgery, Nutrition, Overweight, BMI, Body Mass Index, Decreased Mobility, Comorbidities, Diabetes, Hypertension, REALIZE®, GERD, Bariatric Seminars, REALIZE® Band, Minimally Invasive Bariatric Surgery, StomaphyX™
Expert: Dr. Mathias A.L. Fobi, Mathias A. L. Fobi, M.D., Dr. Fobi, Doctor Fobi, Bariatric Surgeon Dr. Fobi
Expertise: Incisionless Bariatric Surgery, Bariatric Surgery, LAP-BAND®, Laparoscopic Gastric Banding, Gastric Sleeve, Revisional Bariatric Surgery, Sleeve Gastrectomy, Fobi Pouch