It is clear by now that after five years the standard Roux en Y bypass is faced with a considerable amount of re-operations due to weight regain. This can result in up to 30 to even 50% of the initial patients requiring revisional surgery. The main reason for the weight regain is the dilatation of the gastric pouch, eventually accompanied by dilatation of the anastomosis and/or small bowel.
“Although patients lose weight and can be no longer considered obese, some are still psychologically obese and after a year because they can eat more they enter old eating habits,” said Professor Volker Lange, director of adipostas surgery, Vivantes Hospital, Berlin-Spandau, Germany. “The overeating can cause pouch dilatation and subsequent weight gain.”
This can be avoided by placing a gastric ring on the gastric pouch 1-2cm proximally of the anastomosis, thereby creating a neo pyloris that induces an initial barrier to overeating. More importantly, it protects the anastomosis from overstretching. This helps the patients a lot in changing their eating habits, as they experience a stronger and longer-lasting feeling of satiety.
“We use the MiniMizer Ring from Bariatric Solutions which has two major benefits in our view: the ring is equipped with a blunt, silicone covered introducer needle that helps us place the ring without having to dissect posterior to the gastric pouch,” said Lange. “We only need to dissect a small opening in the serosa and the introducer places the ring easily.
The ring also has four closing positions and therefore four different diameters, like a mini tie wrap. Although the pouches can be calibrated with a 36French calibration tube, the thickness of the stomach wall can still vary and the MiniMizer Ring offers the flexibility to close the ring at any desired diameter to match the size of the pouch at hand. It also allows for re-opening if the ring is either too tight or too loose. The material is soft, yet firm and the literature has shown that rings of this size and elasticity have only between 1-2% of erosion, which oftentimes passed via naturalis.
Lange added that the banded bypass is still a very new procedure and although there are no published data from any randomised clinical trials, Konrad Karcz will shortly published the outcomes from a trial comparing banded and non-band laparoscopic Roux-en-Y gastric bypass.
“A recent publication by Awad, who compared banded vs. non-banded bypass over a period of ten years, supports our choice for the banded bypass. We feel the procedure is the way to go and have made a standard part of the therapeutic portfolio."