Ten Years Experience of Banded Gastric Bypass: Does It Make a Difference?

Abstract

Many surgeons support some sort of restriction of the gastric pouch outlet by placing a ring around the gastric reservoir. Previous studies have shown positive results of banded gastric bypass (BGBP); however, there are not many comparative long-term studies to assess the real advantage of placing a ring during gastric bypass (GBP) surgery. This study aims to evaluate the long-term outcome of patients subjected to BGBP and nonbanded GBP procedures. We studied 260 retrospective, nonrandomized obese patients who underwent BGBP and 218 patients without the ring (i.e., GBP). They were followed up for 10 years, and the following parameters were evaluated: excess weight loss (EWL), quality of life (QOL), food tolerance, and correction of comorbidities. The study was approved by the Committee on Ethics, and all the patients gave their informed consent. There is a significant difference in %EWL from the third year until the tenth year of observation, with the proportion being 82% in BGBP versus 63% in nonbanded GBP patients at the end of the study. Although there was some increased intolerance to food intake in the BGBP patients, this was not felt to reduce the QOL. The outcome in terms of comorbidities was not conclusive. There is a clear advantage in terms of %EWL in the BGBP patients. No differences in QOL were found in both groups. Further, selecting the right type of material and the right size of the ring is important to improve results and avoid complications.

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

“…Heneghan et al [14] reported statistically superior weight loss in the banded group at 24 months, and in a sub-group analyses of this study, the authors show that superobese patients (BMI > 50) had even more benefit in terms of %EWL. Another study [17] showed that 10 years following surgery, the banded group achieved 81.7 %EWL compared to 62.3 %EWL in the non-banded group. Data from this study show (Fig.…”

“…Emesis was found to be higher in banded patients compared to non-banded patients, though these were treated conservatively which was successful without requiring any intervention. Awad et al [17] reported 3 band migrations (out of 260 banded surgeries) with a polytetrafluoroethylene (PFTE) ring in the beginning of their study. White et al [5] reported a higher reoperation rate of 27 % of which 7 % were ring removals after silastic ring Roux-en-Y gastric bypass.…”

Standardization of Bariatric Metabolic Procedures: World Consensus Meeting Statement

“…BGBP is as effective as BPD-DS for weight loss and maintenance [104]. Weight loss peaks around 18-24 months after the procedure with maintenance of 70.0-80.0% EWL reported at 4-12 years of follow-up [97,104,105] and significant TBWL of 32.5% [106]. There is slightly better resolution of T2DM and hypertension with BGBP associated with its higher long-term weight loss and maintenance [105].…”

“…Typically, the excellent initial weight loss nadir is followed by 5.0-20.0% EW regain; however, RYGBP weight loss ≥ 50.0% is typically maintained over the long term. In studies 10-year follow-up, T2DM resolves in 50.0-80.0% of RYGBP patients, depending on the severity and duration of disease [96,97], an undeniable attribute of bariatric surgery that caused the American Diabetes Association (ADA) to recommend it in their treatment algorithm [93]. Importantly significantly by 40.0%, particularly deaths from heart disease, T2DM, and cancer [98].…”

Informed Decision-Making for Bariatric Surgery: Benefits, Risks, Uncertainties and Choices

“…No other single study reports 10-year results with the rigour of the SOS; however, a recent meta-analysis of pooled data does confirm that weight loss from Roux-en-Y gastric bypass is maintained long-term [9]. There has been interest in improving the efficacy of the bypass by application of a prosthesis around the anastomosis ("banded gastric bypass") but current data are conflicting [10,11]. Finally, it appears quite clear that both weight loss and disease remission from gastric bypass are inferior to those from BPD with DS [12,13]; these benefits must be balanced with the greater technical demands, intense nutritional follow-up and potential for serious metabolic complications that are inherent to the DS.…”