1. Weight regain after gastric by-pass
Ass Pr Jean BIAGINI

2. Weight regain after gastric by-pass
At 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

3. Weight regain after gastric by-pass Personnal experience
16 cases, Barium UGI study role
3 Adjustable gastric band, 1good result, 2 moderate
1 case gastric pouch reduction, moderate result
1 case alimentary limb lengthening, bad result
2 cases Gastrectomy for gastro-gastric fistula
1 case of jejunal limb diameter reduction
8 cases non-adjustable silicone band

4. Weight regain after gastric by-pass Personal experience, gastric dilation

5. Weight regain after gastric by-pass Personal experience, gastro-gastric fistula

6. Weight regain after gastric by-pass Personal experience, jejunal dilation

7. Weight regain after gastric by-pass Personal experience, anastomotic & jejunal diam reduction

8. Weight regain after gastric by-pass Personal experience, normal UGI

9. Weight regain after gastric by-pass Personal experience, Home made “Fobi ring”

10. Weight regain after gastric by-pass Personal experience, ring on the anastomosis

11. Weight regain after gastric by-pass Personal experience, Weight regain

12. Weight regain after gastric by-pass Personal experience, after band

13. Weight regain after gastric by-pass NH, band failure

14. Weight regain after gastric by-pass NH, mini GBP

15. Weight regain after gastric by-pass NH, weight regain, jejunal dilation>> 7cm fixed band

16. Weight regain after gastric by-pass Non 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.

17. Weight regain after gastric by-pass Conclusions
Importance 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.