Banded gastric bypass - four years follow up in a prospective multicenter analysis

Banded RYGB Ring Slippage Endoscopic Removal with Self-expandable Stents: a Comparative Study Between Metallic and Plastic One

PURPOSE

Banded Roux-en-Y gastric bypass (RYGB) was a common bariatric procedure in the 2000s, and the ring slippage is one of its late adverse events. Both plastic and metallic stents have been reported as adjunct methods to induce erosion and facilitate endoscopic removal of the ring.

OBJECTIVE

To compare the safety and effectiveness of self-expanding metallic stents (SEMS) and plastic stents (SEPS) to treat ring slippage.

MATERIALS AND METHODS

We conducted a retrospective longitudinal study analyzing consecutive patients with ring dysfunction treated with stents plus endoscopic removal.

RESULTS

Ninety patients were enrolled (36 SEMS vs. 54 SEPS). The mean age was 48.56 ± 13.07 and 45.6 ± 12.1 in the SEMS and SEPS groups, respectively. All patients had band slippage, but 24 from SEMS group and 23 from SEPS group had further complications. There were more complications in metallic stent concerning mean absolute number of therapy-related adverse events (1.33 ± 0.48 vs. 1.72 ± 0.5, p > 0.05) and time until erosion (14.9 ± 1.6 vs. 13.8 ± 1.4 days, p > 0.05). Female sex and age > 41 years old correlated with longer time to band erosion and higher incidence of adverse events in SEMS patients. In SEPS group, only female sex was a risk factor for adverse events.

CONCLUSION

Both procedures were efficient at inducing band erosion with similar safety profiles. Older and female patients are at a higher risk of treatment-related adverse events, especially those receiving SEMS.

Laparoscopic Banded Sleeve Gastrectomy: Single-Center Experience with a Four-Year Follow-Up

Introduction: Laparoscopic sleeve gastrectomy (LSG) is now the most common bariatric procedure to treat morbidly obese patients. The main concern of LSG lies in the long-term weight regain, which is reported to happen in up to 75.6% of patients after 6 years. In this study, we report our overall experience with Laparoscopic Banded Sleeve Gastrectomy (LBSG) using the MiniMizer^® over a 6-year period. Materials and Methods: We performed a retrospective review of data from a prospectively collected database. All patients submitted to primary LBSG were examined. Patients were submitted to LBSG between February 2014 and January 2020. Collected data included demographic factors, preoperative body mass index (BMI), operative time, surgical complications, and clinical outcomes. Results: Two hundred nine patients were submitted to primary LBSG in the study period. They were 136 females (65%) and 73 males (35%) with a median age of 43.0 years (range, 18-65 years). Median preoperative BMI was 48.4 kg/m² (range, 36.2-65.5 kg/m²). Median operative time was 72.0 minutes (range, 40-142 minutes). Median time for ring placement was 8.0 minutes. Median postoperative hospital stay was 2.8 days. Seven major complications occurred in the postoperative period (3.3%): five gastric leaks (2.3%) and two major bleedings (0.9%). There was no postoperative mortality in the 209 patients. Long-term major complications occurred in 2 patients (0.9%). Median follow-up was 49.2 months (range, 2-72 months). Median postoperative BMI was 29.6 kg/m² (range, 22-42 kg/m²). Median %excess weight loss (%EWL) at 1 year after surgery was 52.0%. Median %EWL at last follow-up visit was 64.0%. Conclusion: LBSG is as safe as standard LSG with excellent results in terms of postoperative morbidity and weight loss outcomes. Whether this procedure may result superior to standard LSG in the long-term period needs to be evaluated in randomized trials. Clinical Study Registration Number: NCT04354532.

Outcome of revisional bariatric surgery for insufficient weight loss after laparoscopic Roux-en-Y gastric bypass: an observational study

BACKGROUND

Insufficient weight loss or secondary weight regain with or without recurrence of comorbidity can occur years after laparoscopic Roux en Y gastric bypass (LRYGB). In selected patients, increasing restriction or adding malabsorption may be a surgical option after conservative measures failed.

OBJECTIVES

Evaluation of short and long term results of revisional surgery for insufficient weight loss or weight regain after LRYGB.

SETTING

Tertiary hospital.

METHODS

Retrospective analysis of prospectively collected data from a cohort of 1150 LRYGB patients. Included were patients, who underwent revisional bariatric surgery after LRYGB for insufficient weight loss with a follow-up of minimal 1 year.

RESULTS

Fifty-four patients were included in the analysis. After an interdisciplinary evaluation, patients with insufficient weight loss, signs of dumping syndrome, and lacking restriction were offered a nonadjustable band around the pouch (banded group, n = 34) and patients with sufficient restriction, excellent compliance, and adherence were offered a revision to laparoscopic biliopancreatic diversion (BPD group, n = 20). The revisional procedure was performed 3.3 ± 2.3 years after LRYGB in the banded-group and after 6.4 ± 4.3 years in the BPD group (P = .001). Mean body mass index at the time of the primary bariatric procedure was 41.7 ± 6.2 kg/m² in the banded group and 45.2 ± 8.2 kg/m² in the BPD group (P = .08); minimal body mass index between both operations was 29.1 ± 4.7 kg/m² in the banded group and 36.5 ± 9.4 kg/m² in the BPD group, and, at the time of revisional surgery, 31.4 ± 5.5 kg/m² in the banded group and 40.8 ± 6.7 kg/m² in the BPD group (P = .0001). The mean body mass index difference 1 year after revisional surgery was 1.3 ± 3.0 kg/m² in the banded group and 6.7 ± 4.5 kg/m² in the BPD group (P = .01). In the banded group, 11 patients (32.4%) needed removal of the band, 4 patients (11.8%) needed an adjustment, and 4 patients (11.8%) were later converted to BPD. In the BPD group, 2 (10.0%) patients needed revision for severe protein malabsorption.

CONCLUSIONS

Insufficient weight loss or secondary weight regain after LRYGB is a rare indication for revisional surgery. Banded bypass has modest results for additional weight loss but can help patients suffering from dumping. In very carefully selected cases, BPD can achieve additional weight loss with acceptable complication rate but higher risk for reoperation. Future "adjuvant medical treatments," such as glucagon-like peptide 1 analogues and other pharmacologic treatment options could be an alternative for achieving additional weight loss and better metabolic response.

Gastric Emptying and Food Tolerance Following Banded and Non-banded Roux-en-Y Gastric Bypass

INTRODUCTION

Gastric emptying (GE) and food tolerance (FT) can be altered after Roux-en-Y gastric bypass (RYGB) has been performed, especially when it involved the use of a restrictive mechanism (such as a silastic ring).

AIM

To assess GE and FT in patients who underwent banded (BRYGB) or non-banded Roux-en-Y gastric bypass (RYGB).

METHODS

Forty-seven BRYGB patients and 47 RYGB patients underwent gastric emptying scintigraphy (GES) and FT assessment (by means of a questionnaire) between 6 months and 2 years postoperatively.

RESULTS

GES was performed on average 11.7 ± 5.0 months (6 to 24) postoperatively. T½ medians (time taken for the gastric radioactivity to decrease to half of the original value in the gastric pouch) in the RYGB and BRYGB groups were 48.7 min (40.6-183.0 min) and 56.3 min (41.1-390.9 min), respectively (p = 0.031). The median of total questionnaire scores was 24 points (18-27) in the RYGB group and 20 points (13-27) in the BRYBG group (p < 0.001).

CONCLUSIONS

The band (silastic ring) delays GE time and does not affect patient satisfaction or food tolerance to vegetables, bread, or rice, but does affect tolerance to the intake of meat, salad, and pasta. The best tolerated foods are vegetables, salad, and fish. Banded patients are more likely to regurgitate and vomit. Gastric emptying does not affect FT.

Impact of Laparoscopic Banded Gastric Bypass on Weight Loss Surgery Outcomes: 5 Years' Experience

OBJECTIVE

Evaluate 5-year outcomes of banded gastric bypass (BRYGB) as a primary and conversion bariatric procedure.

METHODS

Retrospective review of BRYGB between January 2011and March 2013. Outcomes included percentage of total weight loss (%TWL), weight loss maintenance, and band-related complications.

RESULTS

One hundred forty-two patients underwent BRYGB, 106 primary and 36 conversions. Indications for conversion to BRYGB were complications of the primary procedure (n = 19), insufficient weight loss (n = 5), and weight regain (n = 12). In the primary group, mean preoperative BMI was 44.8 kg/m² (± 6.9 kg/m²). Compared with preoperative weight, mean %TWL was 33.9% (n = 95), 34.1% (n = 82), 34.0% (n = 70), 33.9% (n = 62), and 31.8% (n = 75) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to failed primary procedure (insufficient WL and weight regain), mean preoperative BMI was 40.8 kg/m² (± 6.01 kg/m²). Despite one patient gaining weight, mean %TWL was 25.7% (n = 13), 28% (n = 11), 23.9% (n = 8), 18.3% (n = 8), and 15.1% (n = 12) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to primary procedure complications (n = 19), mean preoperative BMI was 28.4 kg/m² (± 3.5 kg/m²). After 1, 2, 3, 4, and 5 years, mean BMI was 28.1 (n = 15), 29 (n = 10), 29.8 (n = 9), 30.6 (n = 10), and 30.9 (n = 12) kg/m², respectively. Band-related complications after 5 years: three erosion and five patients complained of persistent dysphagia. One band needed reposition. Perioperative surgical complications: two bleeding, one leakage, one port-site hernia, and one food impaction.

CONCLUSION

Banded gastric bypass has good results in terms of weight loss and weight loss maintenance in both primary and conversional bariatric procedures with acceptable incidence of band-related complications.

Surgery in Patients with Super Obesity: Medium-Term Follow-Up Outcomes at a High-Volume Center

OBJECTIVE

There is a need to determine which bariatric operations are the most effective for patients with super obesity and super-super obesity.

METHODS

A retrospective cohort study was performed on patients with super obesity and super-super obesity at Mohak Bariatrics and Robotics Surgery Center in Indore, India.

RESULTS

Five hundred fourteen patients with super obesity and super-super obesity had surgery at our center from January 2010 through December 2013. The baseline characteristics were different in different operations. The initial average age, weight, and BMI were 44.4 (SD 11.9) years, 145.4 (SD 24.2) kg, and 55.48 (SD 5.32) kg/m² , respectively. Sleeve gastrectomy (SG) (227 [44.2%]) was the most common procedure, followed by one-anastomosis gastric bypass (OAGB) (124 [24.1%]), Roux-en-Y gastric bypass (RYGB) (102 [19.8%]), banded sleeve gastrectomy (BSG) (33 [6.4%]), and banded Roux-en-Y gastric bypass (BRYGB) (28 [5.4%]). After 3 years, the percentages of excess body weight loss (%EBWL) for SG, OAGB, RYGB, BSG, and BRYGB were 62.38%, 78.59%, 69.55%, 85.11%, and 75.77% (P < 0.0001), respectively. Failure to achieve BMI < 35 kg/m² was more frequent in the group who underwent SG (67.9%), followed by RYGB (29.16%), BRYGB (22.2%), OAGB (9.87%), and none in the BSG group.

CONCLUSIONS

BSG, OAGB, and BRYGB have very good to excellent midterm outcomes for patients with super obesity and super-super obesity, whereas RYGB and SG have average outcomes at 3 years. There is a need for multicenter, long-term, and prospective studies to be performed to confirm these findings.

OAGB vs BGBP: A retrospective comparative study of a cohort of patients who had bariatric surgery in 2012 at one centre by a single surgeon

Two modifications of Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and Roux-en-Y banded gastric bypass (BGBP), are gaining popularity in use because the OAGB is reported to be a simpler operation, and the BGBP is reported to have sustained weight loss compared to standard RYGB. A retrospective review and analysis of data comparing outcomes up to 5 years after BGBP and OAGB from a prospectively maintained database of all bariatric metabolic operations in 2012 was performed. Eighty-two patients underwent a BGBP and 90 an OAGB. The average age and body mass index were 44.12 and 43.97 and 43.57 and 45.79 in the BGBP and OAGB groups, respectively. Postoperative nutrient deficiencies were similar in both groups but were more prominent in the OAGB group. The % excess body weight loss (%EBWL) was 78% and 71.5% at 5 years in the OAGB and BGBP groups, respectively. The % total weight loss (%TWL) was also higher in OAGB compared to the BGBP group, 34.72% and 30.49%, respectively. Resolution of type 2 diabetes (T2DM) was significantly higher in the OAGB group, 79.16%, than in the BGBP group, 71.42%. The resolution of dyslipidaemia and hypertension were similar in both groups, but sleep apnoea resolution was higher in OAGB group. Both operations produced excellent weight loss in the intermediate term. The %EBWL and resolution of T2DM were significantly higher after the OAGB operation at the expense of increased incidence of nutrient deficiencies and hypoproteinemia. Quality of life improvement and patient satisfaction were high after both operations. Long-term follow up and multicentre prospective studies are needed to confirm these intermediate outcomes.

Banded versus nonbanded sleeve gastrectomy: 5-year results of a matched-pair analysis

BACKGROUND

Laparoscopic sleeve gastrectomy (SG) achieves excellent weight loss, yet recent reports indicate weight regain in a substantial number of patients.

OBJECTIVES

Inserting a nonadjustable gastric band may improve weight loss after SG.

SETTING

University Hospital, Germany.

METHODS

In a retrospective matched-pair analysis 51 patients who underwent banded SG (BSG) using a silicone ring between November 2010 and May 2017 were compared with patients who underwent conventional SG regarding weight loss, complications, and co-morbidity. Median follow-up was 5 years.

RESULTS

Total weight loss was equal in the early follow-up (P = .118 and P = .111) but significantly better in BSG 3 and 5 years after surgery (BSG versus SG at 3 yr 38.7% ± 7.8, n = 33 versus 31.9 ± 10.7, n = 33, P = .002; BSG versus SG at 5 yr 37.6% ± 8.5, n = 27 versus 29.5 ± 12.9, n = 23, P = .008). Ring placement had no significant impact on clinical reflux signs (Fisher's exact test P > .999), yet 37 % of BSG patients reported ≥1 regurgitation per week (Fisher's exact test P = .013, odds ratio 12.4).

CONCLUSION

BSG leads to better weight loss than nonbanded SG 5 years after surgery. This comes at the expense of a higher rate of regurgitation. At a time in which weight loss limitations of a stand-alone SG are becoming a clinical problem, banding the sleeve may be a strategy to improve weight loss with this procedure.

Banding the Sleeve Improves Weight Loss in Midterm Follow-up

INTRODUCTION

Laparoscopic sleeve gastrectomy (LSG) can achieve excellent weight loss, yet sleeve dilatation with concomitant weight regain proves to be a relevant issue. Hence, additional restriction might improve results after LSG.

METHODS

In a retrospective matched-pair analysis, 42 patients who underwent banded LSG (BLSG) using a MiniMizer® ring between January 2012 and October 2014 were analysed regarding weight loss, complications and comorbidity. Median follow-up was 3 years. Forty-two patients who had undergone conventional LSG were selected as matched pairs.

RESULTS

Mean preoperative BMI was 54.93 ± 7.42 kg/m² for BLSG and 53.46 ± 6.69 kg/m² for LSG (Mann-Whitney P = 0.540). Total weight loss (%TWL) was significantly greater in the BLSG group 3 years after surgery (BLSG 38.22% ± 7.26; n = 26 vs. LSG 32.69 ± 9.47; n = 26; P = 0.0154). Ring placement had no relevant impact on new-onset reflux (Fisher's exact test P = 1.0) but a tendency towards reflux improvement when reflux pre-existed (odds ratio 1.96). The major side effect of ring implantation was regurgitation with over 44% of patients presenting with regurgitation >1 per week (Fisher's exact test P = 0.0019, odds ratio 18.07).

CONCLUSION

BLSG is a safe procedure showing similar comorbidity to conventional LSG. However, BLSG leads to a higher rate of postoperative regurgitation. Weight loss is significantly improved 3 years after surgery. Hence, additional ring implantation might be an option for increased restriction in LSG surgery.

Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up

BACKGROUND

While gastric bypass has been the treatment of choice for morbid obesity, insufficient weight loss and even weight regain has been observed in a sub-group of patients. Dilatation of the pouch, pouch outlet, and proximal alimentary limb have been suggested to cause weight regain on the long term. The banded gastric bypass surgery has been introduced to overcome this problem.

METHODS

Four hundred thirty-two patients (n = 254, non-banded/n = 178, banded-GaBP Ring™) were followed-up for 5 years. Patients were evaluated for weight loss, % excess weight loss (%EWL), weight regain and BMI.

RESULTS

No significant differences between groups in the first year following surgery were observed in terms of weight loss and %EWL. %EWL at 5 years was as follows: non-banded 65.2 ± 20.0 %; banded 74.0 ± 15.1 %. At 5 years, the banded group showed more weight loss (non-banded 35.4 ± 12.5; banded 43.9 ± 11.9 kg, P < 0.0001); weight regain was significantly higher in the non-banded group (P < 0.0001). Only minor complications were reported; no signs of ring migration or slippage were reported.

CONCLUSION

Although, following the first year after surgery, no differences in treatment groups were observed in terms of weight loss, 5 years following surgery, patients who received banded surgery maintained better weight loss and had less weight regain compared to the non-banded group. These results suggest that laparoscopic banded gastric bypass using a silastic ring was effective in maintaining weight loss on the long term, while the complication rate was low. The banded gastric bypass is regarded by us as the new gold standard.

Comparison Between Banded and Nonbanded Roux-En-Y Gastric Bypass with 2-Year Follow-Up: a Preliminary Retrospective Analysis

BACKGROUND

Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries for treatment of moderate and severe obesity. Placing a band around the pouch to band the gastric bypass operation has been reported to increase the restriction resulting in better weight loss and weight loss maintenance. A retrospective comparative study of banded versus nonbanded gastric bypass was done to see if banding the pouch made a difference in the weight loss and quality of life outcome in the patients.

METHODS

Data from all patients who had a gastric bypass in the year 2012 at our centre were reviewed. They were divided into two groups the banded and the nonbanded groups. Patients with complete 2-year follow-up were analysed in terms of weight loss, weight regain and quality of life changes.

RESULTS

Two hundred ten patients had gastric bypass in 2012; 165 had complete 2-year follow-up; 64 were banded and 101 nonbanded. The preoperative patient profile in terms of weight, gender and comorbid conditions was similar in both groups except the body mass index (BMI) was significantly higher in the banded group. The perioperative and postoperative complication rates were similar. The weight, BMI and percentage excess weight loss (PEWL) at 2 years were 80.93 kg, 29.45 kg/m2 and 60.76 % in the nonbanded group and 77.06 kg, 27.66 kg/m2 and 71.45 % in the banded group, respectively. Resolution of comorbid conditions was the same in both groups. The overall Gastrointestinal Quality of Life Index went from 88.98 preoperatively to 109.33 postoperatively in the nonbanded group and 92.5 to 112.81 in the banded group, respectively.

CONCLUSIONS

The patients with banded gastric bypass had significantly better results in terms of weight loss, weight stability and Gastrointestinal Quality of Life Index scores at 2 years.

Laparoscopic Band-Separated One Anastomosis Gastric Bypass

BACKGROUND

This video demonstrates laparoscopic band-separated one anastomosis gastric bypass-combining the advantages of banding and gastric bypass without stapler and cutter use. This is basically a gastrojejunal loop bypass above an obstructive band in the upper stomach.

MATERIALS AND SURGICAL TECHNIQUE

An adjustable low pressure "Medsil" gastric band was introduced in the abdomen and retracted through the retrogastric tunnel. The front wall of the stomach below the band was displaced in the upward direction through the ring band, increasing the size of the anterior portion of the stomach pouch so that a gastroenteroanastomosis could be created at this point. Gastro-gastric sutures were placed to create a gastro-gastric plication around the band and hold it in position. The band tubing was exteriorized and connected to a special port, which was secured to the abdominal wall fascia. A jejunal loop was created about 200 cm from the ligament of Treitz and anastomosed to the gastric pouch by hand using Vicryl 2/0 sutures.

RESULTS

Between November 2015 and February 2016, the study was performed on 10 patients. The average operating time for all cases was 75 min (range 63-87). There was no morbidity or mortality. No complications were observed, including band erosion and band infection. Operation costs were about $2000 lower with this method than with standard gastric bypass surgery. Postop the patients lost weight by 3-4 kg per month.

CONCLUSION

Preliminary results show that laparoscopic band-separated one anastomosis gastric bypass have feasibility, safety, efficacy, and reduced operating costs.

Laparoscopic removal of gastric band after laparoscopic gastric bypass and following placement of adjustable gastric band

Banded gastric bypass is a bariatric surgical intervention that has been regularly performed in many centers. According to some series, banded gastric bypass is safe and feasible. We describe the case of a 42-year-old woman undergoing laparoscopic gastric bypass in 2008. Subsequently, she underwent surgery in order to place adjustable gastric banding on previous bypass because of gastric pouch dilatation. Five months later, patient showed anorexia and signs of malnutrition. For this reason, she underwent laparoscopic removal of gastric banding. In our opinion, placing a device to restrict an already dilated gastric pouch must be avoided.