The addition of a silicone ring to a Roux-en-Y gastric bypass (banded- RYGB) results in the maintenance of weight loss ten years post-operative, according to a study by researchers from the Zuyderland Medical Center (ZMC) in The Netherlands. In addition to decreased weight loss occurrence, the procedure also reduced the number of associated medical problems and lowered the number of patients with long-term complications.
“We have been performing the banded RYGB for many years in our institution and have seen very positive results up to five years of follow-up,” explained Dr Evert‑Jan Boerma, a bariatric surgeon from the Zuyderland Medical Center in Heerlen, The Netherlands. “However, results up to ten years were not available in our practice or easily available in literature. Therefore, we set out to obtain these long-term follow-up data by contacting a cohort of patients.”
Between January 2011 and March 2013, the study recruited 149 patients - 110 received a primary banded-RYGB and 39 received a conversional banded-RYGB. The majority of the patients were female in both groups (68% and 77%, respectively). Previously, the five-year post-operative results have already been published by Galal et al (Impact of laparoscopic banded gastric bypass on weight loss surgery outcomes: 5 years’ experience. Obes Surg. 2020;30(2):630–9). In this latest study, the investigators report on the post-operative outcomes for the years 6–10. At ten years follow-up, 67.1% of the data was available for analysis (49 patients lost to follow-up, 31 patients (28.2%) from the primary group and 18 patients (46.2%) from the conversional group).
The reasons for conversional surgery included dysphagia (61.5%), weight recurrence (25.6%), insufficient weight loss (7.7%), pouch dilatation (2.6%) and staple line dehiscence (2.6%). The average time between the primary and conversional surgery was 129.7 (± 76.7) months. Of the 39 conversional surgeries performed, 28 (71.8%) were vertical banded gastroplasty, seven (17.9%) were sleeve gastrectomy, three (7.7%) were adjustable gastric band and one (2.6%) RYGB.
Importantly, the investigators noted that initially, the standard ring size was 6cm for females and 6.5 cm for males and conversional surgery. However, this was changed to the standard ring size of 6.5 cm for females and 7.0 cm for males and conversional surgery due to early dysphagia.
The breakdown of ring size was as follows - in the primary group, most patients had a ring size of 6.5cm (48.2%), followed by 7.0 (21.8%) and 7.5 (20.9%). Only nine patients (8.2%) had a ring size of 6.0 and one (0.9%) of 8.0. In the conversion group, 30 patients (76.9%) had a ring size of 7.0, 5 (12.8%) of 6.5, and 2 patients (5.1%) had 7.5, and 2 patients (5.1%) had a 8.0-cm ring.
No rings were removed between six- and ten-years post-operative in the primary group. However, in 5 patients, the ring was repositioned or replaced with a new silicone ring for erosion, dysphagia, slippage, stenosis or a broken ring. For the conversional group, two patients had their ring removed due to erosion of the ring.
When using a ring (e.g. the Minimizer) around the gastric pouch you should not place the ring to tight, the fit should be loose,” Dr Boerma cautioned. “When calibrating on a 40 French gastric bougie, 7.0cm for females and 7.5cm for males is the right choice in the vast majority of patients.”
The outcomes revealed that %TWL over time first increases up to a mean of 34.1% at two years, decreasing only slightly to 30.0% at ten years post-operative in the primary group. For the conversional group, there was a mean %TWL of 6.9 at ten years after revision.
With regards to associated medical problems, the number of patients suffering from hypertension and obstructive sleep apnoea syndrome (OSAS), decreased, and stayed low until at least ten years after the operation. There was also a decrease in diabetes and dyslipidaemia, at ten-years compared to baseline to 29.6% and 20% respectively.
At five years, the remission rate in the primary group from diabetes was 75.9%, hypertension 42.9%, OSAS 52.0% and dyslipidaemia 60.6% at 5 years vs. 53.3%, 51.4%, 61.9% and 46.2% at ten years.
“Adding a Minimizer ring to a Roux-en-Y gastric bypass results in sustained long-term weight loss with a significant reduction of associated medical problems compared to baseline, and an acceptable number of long-term complications,” he concluded. “This is the first long-term follow-up study of the result of banded gastric bypass with a follow-up percentage >70% after ten years, which demonstrates sustained long-term weight loss and less weight regain, compared to the long-term data on RYGB available in literature.”
The outcomes were reported in the paper, 'Convincing 10-Year Follow-up Results of the Banded Roux-en-Y Gastric Bypass', published in Obesity Surgery. To access this paper, please click here
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