Most recent update: Friday, October 19, 2018 - 08:09

Bariatric News - Cookies & privacy policy

You are here

Banded procedures

Banded bypass, sleeve and OAGB for primary and revision procedures

Dr Bhandari has performed more than 1,200 banded bariatric procedures including banded gastric bypass, sleeve and one anastomosis gastric bypass

The number of banded bariatric procedures has risen in recent years due to its ability to prevent weight regain, compared to non-banded procedures. Bariatric News talked to Dr Mohit Bhandari - Founder, Director and Chief Surgeon at Mohak Bariatrics and Robotics, Indore, India – about his experience with banded bariatric procedures and why he now recommends these operations for primary and revisional procedures.

“Patients gain weight after bariatric surgery due to the dilatation of the pouch and elongation of roux limb due to patient’s overeating and not adhering to their post-operative eating regimes,” Dr Bhandari began. “The gastric pouch in any bariatric procedure dilates with time and it is natural that this tissue expands some years after bariatric surgery. However, a banded bypass or sleeve limits this expansion and maintains the size of the gastric pouch by preventing pouch dilation.”

Dr Mohit Bhandari

Dr Bhandari performed his first banded bypass in 2011 and has subsequently performed more than 1,200 banded bariatric procedures including banded gastric bypass, sleeve and one anastomosis gastric bypass (OAGB), as well as more than 200 revision procedures converting a sleeve gastrectomy to banded gastric bypass and more than 1,500 robotic banded procedures.

"We strongly recommend to all patients who are undergoing a primary bariatric procedure that they receive a banded bariatric procedure as this will result in better weight loss maintenance.”

There are three mechanisms by which weight is maintained by banded procedures. Firstly - by preventing the dilatation of the pouch, secondly - by forced compliance and, thirdly - by preventing the patient to ‘eating into the roux limb’ as the pouch prevents overeating,” he explained. “In long term, this assists in maintaining weight loss and preventing weight regain. The term ‘forced compliance’ means the patient cannot bulk eat, they have to chew and masticate the food more efficiently. We know from the literature evidence and patient experience that in patients who undergo banded procedures the feeling of fullness is maintained, whereas meal portions increase and a feeling of fullness is not evident overtime in non-banded patients.”

Evidence

According to Dr Bhandari, most published studies have reported weight regain years after sleeve gastrectomy and gastric bypass of 10-50%. However, there is now sufficient evidence in the literature and from his own experience to support banded procedures. Numerous papers published by Mal Fobi, Luc Lemmens, Phil Schauer and others, have demonstrated the long term superiority of banded procedures, compared with the non-banded ones, he added.

He cited the paper by Dr Luc Lemmens et al (Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients, Obesity Surgery, April 2018) that demonstrated non-banded sleeve patients had a higher weight loss failure rate (35.2%) and weight regain (19.6%) at the five-year follow-up, compared to banded patients (p<0.001). Moreover, a second paper by Luc Lemmens et al (Banded gastric bypass - four years follow up in a prospective multicenter analysis, BMC Surgery, November 2018), reported banded gastric bypass results in good weight loss with no regain weight after four years.

A paper by Schauer et al (Banded Roux-en-Y gastric bypass for the treatment of morbid obesity, SOARD, 2014), showed that at two years the average %EWL was 58.6% in banded bypass patients and 51.4% in the non-banded group (p=0.015). Interestingly, the difference in EWL was more pronounced in patients with super-obesity than in those with BMI<50 (among super-obese, 57.5% vs. 47.6%, p=0.003; among those with BMI<50, 62.9% vs. 57.9%, p=0.406)

"Many of my colleagues now perform banded procedures. Banded procedures have a strong place in the armamentarium in super obese and young patients, well as revisional operations.”

In addition, Dr Bhandari’s published study (Comparison Between Banded and Nonbanded Roux-En-Y Gastric Bypass with 2-Year Follow-Up: a Preliminary Retrospective Analysis, Obesity Surgery, January 2016), reported that weight, BMI and percentage excess weight loss (PEWL) at two years were 80.93kg, 29.45kg/m2 and 60.76% in the non-banded group vs 77.06kg, 27.66kg/m2 and 71.45% in the banded group.

“In my opinion, there is little doubting the evidence from our own centre and from the published literature that banded bariatric procedures result in better long-term outcomes vs. non-banded procedures,” he added. “This is why we strongly recommend to all patients who are undergoing a primary bariatric procedure that they receive a banded bariatric procedure as this will result in better weight loss maintenance.”

Interestingly, Dr Bhandari added that it is patient preference that leads patients to opt for banded bariatric procedures, after they see the results it “inspires them” to choose banded bariatric procedure over non-banded ones.

Although he previously used the Fobi Ring, he now uses the MiniMizer Ring (Bariatric Solutions,) as it has a smooth locking mechanism that helps when adjusting the size and calibration. In addition, the thickness of gastric pouch differs between patients, so the adjustability of the MiniMizer Ring to close in different positions offers a significant advantage over similar devices (Figure 1).

Figure 1: The MiniMizer Ring can close in different positions offering a significant advantage over similar devices

“In my opinion, banded procedures are more useful in patients with super obesity and for complex revisions, when converting sleeve to banded gastric bypass, my preference is robotic surgery. The published literature shows that this group of patients initially lose more weight, however, they tend to gain weight with passage of time. Banding the pouch clearly helps to prevent weight regain,” concluded Dr Bhandari. “Most surgeons who maintain their own long-term data have seen efficacy by banding the pouch in both sleeve and bypass patients, this is the reason why many of my colleagues now perform banded procedures. Banded procedures have a strong place in the armamentarium in super obese and young patients, well as revisional operations.”

For further information, please contact:

info@bariatric-solutions.com or visit www.bariatric-solutions.com

Want more stories like this? Subscribe to Bariatric News!

Bariatric News
Keep up to date! Get the latest news in your inbox. NOTE: Bariatric News WILL NOT pass on your details to 3rd parties. However, you may receive ‘marketing emails’ sent by us on behalf of 3rd parties.