Banded- Roux-en-Y gastric bypass (RYGB) is associated with statistically significant increases in percentage excess weight loss (% EWL) at one, two and five years post-operatively, compared to RYGB alone, according to a systematic review and meta-analysis by an international team of researchers. Although the study showed a slightly higher rate of complications within the Banded-RYGB group, the difference was not statistically significant.
The authors stated that there is a previous meta-analysis that identified eight unique peer-reviewed studies of Banded-RYGB and RYGB procedures with patient outcome data suggesting that both procedures are associated with similar %EWL at 1 and 2 years, while BRYGB was associated with an increase in %EWL at 5 years after surgery (Magouliotis DE, et al. Banded vs. non-banded Roux-en-Y gastric bypass for morbid obesity: a systematic review and meta-analysis. Clin Obes. 2018 Dec;8(6):424-433). However, the aim of this meta-analysis was to observe the same data in a larger number of patients with more recent manuscripts, so that the results give a more statistically significant contribution to the literature.
The systematic review and meta-analysis included 13 comparative studies involving 3,230 patients who underwent banded-RYGB and 5,302 who received RYGB. The primary outcomes were represented by postoperative one-, two-, and five-years weight loss described as % EWL, with secondary outcomes were postoperative complications rates.
Outcomes
The researchers noted that four studies reported one-year postoperative %EWL including 2,103 patients and analysis showed a significantly increased 6.03 (p=0.0253) %EWL for patients who underwent banded-RYGB. Sensitivity analysis revealed a significant increase of 3.3 (p=0.001) %EWL for patients who underwent Banded-RYGB one-year after surgery.
Two-year postoperative %EWL including 1,208 patients (four studies) reported that patients who had banded-RYGB showed a 5.32 (p=0.225) greater %EWL than individuals who received RYGB, though the difference was not statistically significant. However, a significant 10.29 (p=0.0001) greater %EWL for patients with banded-RYGB vs RYGB.
At five-years, with a total of 2,317 patients (five studies), the mean %EWL difference was 7.6 (p=0.01) in favour of banded-RYGB. Postoperative complication (includes regurgitation, dysphagia, nausea or obstructive band slippage) rate was evaluated as secondary endpoint and patients who underwent banded-RYGB had a non-significant 1.45 (p=0.91) OR of developing postoperative complications vs. patients receiving RYGB.
In all but two studies, banded-RYGB was performed with a silicone ring. Only four studies reported the size of the bougie used for calibration, which varied from 32 to 38 Fr.
“Overall, the use of the band promotes greater long-term weight loss, reducing the risk of recurrent weight gain, particularly in patients with a higher BMI. Although not sustained by clear evidence, adding band in patients with recurrent weight gain after RYGB could be considered a possible option,” the authors noted. “However, the risk to increase functional gastrointestinal symptoms with this strategy should also be put in the global benefit-risk balance.”
In addition, they stated whilst concerns about ring migration and slippage do exist, the actual occurrence rate of ring-related issues is relatively low and can be resolved without serious complications.
“These findings suggest that the Banded-RYGB procedure has a more potent effect on weight loss, particularly in the long term, compared to the RYGB procedure. The rates of short-term complications are similar in both groups but there is not enough data to assess the long-term evolution of Banded-RYGB patients, as well as the rate of complications and need for band removal,” the authors concluded. “Future studies are needed to gain a clearer understanding of the optimal band characteristics and more meaningful outcomes such as band-related complications and % EWL, in order to show differences in efficacy and safety between Banded-RYGB and RYGB.”
The findings were featured in the paper, ‘Banded versus non-banded Roux-en-Y gastric bypass: short, mid, and long-term surgical outcomes - a systematic review and meta-analysis’, published in SOARD. To access this paper, please click here (log-in maybe required)
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