The most popular and effective surgical obesity procedure is the Roux-en-Y gastric bypass (RNYGB) that is both a restrictive procedure, by creating a small gastric pouch, and a malabsorptive reconstruction by way of the creation of a jejunal bypass. Studies show that following RNYGB, patients lose about 67% of their excess weight at 1-2 years after surgery.  However, RNYBG will fail in some 20-35% of patients for a variety of reasons that are likely multifactorial.