Ring-augmented RYGB in patients with BMI≥50 leads to significant weight loss and improvement in obesity-related complications

Ring-augmented RYGB (raRYGB) with a MiniMizer Ring in patients with BMI≥50kg/m2, results in significant weight loss and improvements in obesity-related complications with an acceptable complication rate, according to researchers from The Netherlands.

The study’s authors said that numerous studies have shown that the augmentation of the gastric pouch of a RYGB has demonstrated superior long-term weight loss outcomes and better weight maintenance, compared to standard RYGB. However, they noted there is limited literature specifically addressing the use of silicone rings, such as the MiniMizer Ring, designed for raRYGB in patients with BMI≥50kg/m2.

Subsequently, they designed a study to evaluate the effectiveness and safety of ring augmentation of RYGB with a MiniMizer ring up to two years after surgery in patients with BMI≥50kg/m2. In this retrospective study, 171 consecutive adult patients with a BMI of 50 ≥ kg/m2 who underwent a primary laparoscopic raRYGB with a MiniMizer ring in the Zuyderland Medical Center (ZMC) between July 2016 and December 2021, were included in this study.

The primary outcome was %TWL which is calculated using weight prior to the surgery and was investigated at intervals of three months, six months, one year and two years after surgery. The secondary outcomes of this study comprise of post-operative complications, and obesity-related complications.

Of the 171 patients, 78% were female, with a median age of 42 years and a median BMI of 54kg/m2. At baseline, 24 patients (14%) had diabetes mellitus, 59 patients (35%) had hypertension, 35 patients (21%) had obstructive sleep apnoea syndrome (OSAS) and 14 patients (8%) had dyslipidaemia.

Outcomes

Mean TWL in patients with a BMI>50 kg/m2 who underwent a raRYGB with a MiniMizer ring was 16% (± 5.2) at three months, 25% (± 6.0) at six months, 32.1% (± 7.4) at one year and 35% (± 8.9) at two years post-operatively (Figure 1). There was also a significant reduction in BMI, with a median BMI of 35.7 kg/m2 (IQR 31.8–39.0) at one year and 34.0 kg/m2 (IQR 30.0–38.4) at two years.

Figure 1: Mean TWL over the study period

Regarding obesity-related complications:

• The percentage of patients with T2DM decreased significantly from 14% at baseline to 3.8% at one year and further to 3% at two years (p<0.05)

• Hypertension decreased from 35% at baseline to 22% at one year and 18% at two years (p < 0.05).

• OSAS decreased significantly from 21% at baseline to 8% at one year and 9% at two years (p < 0.05).

• Dyslipidaemia prevalence showed a slight reduction, from 8% at baseline to 8% at one year and 5% at two years (not statistically significant).

Complications within 30 days post-surgery occurred in eight patients (5%), one (1%) of which was ring-related dysphagia. The majority of early complications consisted of anastomotic leakages (n=5, 3%). Seventeen patients experienced late complications,  two were ring-related (1%). The most common late complication was internal herniation (n=9, 5%). There were no instances of revisional or conversional surgery.

“Future research should focus on longer-term follow-up and comparative studies with other bariatric procedures for patients with BMI ≥ 50 kg/m2,” the authors concluded. “Additionally, investigating factors that contribute to the success of raRYGB in this population could help refine patient selection and surgical techniques.”

The findings were featured in the paper, ‘A Ring-Augmented Roux-en-Y Gastric Bypass with MiniMizer Ring is Effective and Safe in Patients with a BMI >50 kg/m2’, published in Obesity Surgery. To access this paper, please click here