Bariatric News talked to Professor Rudolph Weiner, Head of the Department of Surgery of the Frankfurt Sachsenhausen Hospital, Frankfurt, Germany, who discussed the growing trend of using a ring in gastric bypass and sleeve gastrectomy procedures. He cited the example of a sleeve gastrectomy where the antrum region of the stomach, before the pylorus, can become dilated and as a result the capacity of the sleeve increases.
“Just after a sleeve gastrectomy the capacity of the stomach is approximately 50cc, after a couple of years we have seen a marked increase in the stomach’s capacity up to 100-120cc, and after six or seven years this increases to 180- 200cc capacity.”
According to Weiner, the solution is not more surgery but preventing dilatation by performing banded procedures. “By banding the bypass and sleeve we are able to protect the anastomosis of the bypass and prevent dilatation of the sleeve, prevent overstretching, minimise dumping syndrome, as well as stabilising long term weight loss.”
The MiniMizer Ring (Bariatric Solutions) has been specially designed to prevent dilatation and is very easy to place and close, aided by a blunt, silicone covered introduction needle that simplifies retrogastric placement.
The MiniMizer Ring also provides the surgeon with several benefits, particularly the ease of which the device can be adjusted to the desired diameter. The Ring can be closed in 6.5cm, 7.0cm, 7.5cm and 8.0cm circumference and this enables the surgeon to focus on the patients’ individual requirements.
“The device can be used in primary bypass and sleeve procedures,” he explained. “If the patient presents with pouch dilatation, the MiniMizer Ring can be used in a revision procedure to re-enforce the restriction, thereby preventing weight regain and associated problems such as dumping syndrome.”
There is an increasing amount of longterm published data, which supports the use of banded, as well as studies such as the Banded Versus Conventional Laparoscopic Roux-en-Y (GABY) clinical trial, which reported considerable higher EWL after a couple of years in banded patients and fewer instances of weight regain, compared to non-banded gastric bypass.
In addition, Weiner said that using the MiniMizer Ring could be particularly beneficial for patients who have an eating disorder and who have a higher BMI class (>50), as they may need additional restriction and can subsequently achieve greater weight loss.
He also added that complications from banded procedures such as migration or erosions are rare, take place without serious issues, and are normally rectified without the need of additional surgery but via an endoscopic procedure.
“The MiniMizer Ring provides surgeons with a new option to prevent weight regain in patients,” he concluded. “Utilising devices such as the MiniMizer Ring, when performing banded bypass or sleeve gastrectomy allows surgeons to maximise weight loss, whilst adhering to the principles of restrictive procedures.”