Question: A 63-year-old man presented for management of his morbid obesity. The history goes back to September 2005 when the patient presented with a body mass index (BMI) of 40 kg/m2 (123 kilograms to 175 cm). An adjustable gastric band (AGB) was placed. The AGB failed at long term, the patient regained weight and reached a BMI of 41 kg/m2. Removal of the AGB and conversion to Roux en Y gastric bypass (RYGB) was performed in May 2009. Two years after the RYGB, the patient regained weight. A 3-dimensional computed tomography (CT) volumetry of the gastric pouch was done that showed a dilation of the gastric pouch.