Ring-augmented Roux-en-Y gastric bypass superior to standard RYGB

Three-year outcomes from a randomised control trial have revealed that ring-augmented Roux-en-Y gastric bypass (rRYGB) is superior to standard RYGB in terms of percentage excess weight loss (%EWL), percentage total weight loss (%TWL) and reduced recurrent weight gain (RWG), according to researchers from Egypt.

Ring-augmented Roux-en-Y gastric bypass

“These advantages were accompanied by smaller gastric pouch volumes, narrower gastrojejunostomy anastomoses and alimentary limbs, and a lower incidence of dumping syndrome at three years postoperatively, including a ring potential benefits the enhancement of long-term outcomes by maintaining the restrictive and functional integrity of the surgical alterations,” the study authors noted.

This single-blinded, randomised controlled trial was conducted in two specialised bariatric centres and included 240 patients, 120 who had a rRYGB and 120 who had a RYGB patients operated on between January 2019 and March 2020. Participants aged between 18 and 60 years were included with a body mass index (BMI) of ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with associated medical problems. The primary endpoint was weight loss (WL), assessed by the %EWL and %TWL.

Secondary endpoints included gastric pouch and gastrojejunostomy volumetry, complications, quality of life (QoL), food tolerance (FT), associated medical problems, and recurrent weight gain (RWG, > 20% of TWL). Patients in the rRYGB group received the MiniMizer Gastric Ring, Bariatric Solutions International, Switzerland).

Outcomes

Operation time was significantly shorter in the RYGB group (88.3 ± 3.1 min) compared to the rRYGB group (93.0 ± 3.0 min) (p<0.001). There were no significant differences between the two groups in early (5.8% vs. 6.7% p1.000) and late complications (24.2% vs. 25.8% p = 0.882). One case (0.8%) in the rRYGB had erosion of the ring and was re-operated and fully recovered. There were no significant differences in reoperations (1.7% vs. 3.3% p=0.684) and endoscopy in years one and three.

No significant differences in weight, BMI, %TWL or %EWL were observed between the two groups in year one and year two of follow-up. At year three, rRYGB showed statistically significant higher %TWL (40.3 ± 2.1% vs. 39.0 ± 2.5%) and %EWL (92.9 ± 11.2% vs. 89.1 ± 9.5%) compared to nrRYGB, with mean differences of 1.3 (95% CI, 0.6 to 2.0; p<0.001) and 3.8 (95% CI, 0.8 to 6.7; p= 0.012) in %TWL and %EWL, respectively.

Additionally, the rRYGB group demonstrated a significantly lower mean RWG in kg than nrRYGB (0.8 ± 1.6 kg vs. 2.1 ± 2.4 kg), with a mean difference of − 1.3 kg (95% CI, − 0.7 to − 1.8, p<0.001). The mean percentage of RWG per maximum weight loss was significantly lower in rRYGB (1.7 ± 3.3% vs. 4.4 ± 5.0%), with a mean difference of − 2.7% (95% CI, − 1.4 to − 3.9, p<0.001).

Aalysis of common channel lengths immediately after surgery confirmed baseline equivalence between the nrRYGB and rRYGB groups. The mean common channel length was 437.3 ± 49.3cm in the nrRYGB group and 430.2 ± 44.0cm in the rRYGB group, with no significant difference (p=0.241). This equivalence remained consistent across all analysed cohorts, despite patient dropout, with no significant differences observed at any follow-up period.

There were no statistically significant differences in the RAND-36 score outcomes between the nrRYGB and rRYGB groups in post-operative year three. When adjustments for surgery type, there were statistically significant improvements in all domains and total scores after surgery compared to pre-baseline (p<0.001), with no significant differences detected between both procedures.

The volumetric measurements of the gastric pouch in the rRYGB group demonstrated significant changes between six months and three years postoperatively. The mean volume of the pouch segment above the ring increased significantly from 25.7 ± 3.9 mL at six months to 41.9 ± 5.5 mL at three years (p<0.001). In contrast, the mean volume of the pouch segment below the ring decreased significantly from 16.9 ± 3.1 mL at six months to 14.3 ± 3.3 mL at three years (p<0.001). Additionally, the mean distance between the ring and the anastomosis was significantly reduced, from 2.4 ± 0.5 cm at six months to 1.5 ± 0.5 cm at three years (p<0.001).

“These findings underscore the potential benefits of ring-augmented procedures in Roux-en-Y gastric bypass and highlight the need for continuous research into their application,” the researchers concluded. “Long-term multi-centre studies assessing outcomes such as weight maintenance, quality of life, nutritional deficiencies and metabolic improvements will be essential to refine these techniques and optimise patient care.”

The findings were featured in the paper, ' Three-Year Results of Comparison Between Ring- versus Non-ring-Augmented Roux-en-Y Gastric Bypass: A Randomized Control Trial', published in Obesity Surgery. To access this paper, please click here