The Benefits of Banded over Non-banded Roux-en-Y Gastric Bypass in Patients with Morbid Obesity: a Multi-center Study.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has proven to be an effective treatment for obesity with excellent long-term results, even though weight regain can occur. A method to improve the results of RYGB and minimize chance of weight regain is banded RYGB. Better sustained weight loss is also related to higher remission of comorbidities. The aim of this study was to evaluate the effect of banded and non-banded RYGB on long-term weight loss results and comorbidities. METHOD: A retrospective comparative data study was performed. Patients who underwent a primary RYGB between July 2013 and December 2014 and followed a 5-year follow-up program in the Dutch Obesity Clinic were included. Comorbidities were assessed during screening and follow-up. RESULTS: The study included 375 patients with mean weight and body mass index (BMI) of 128.9 (± 21.2) kg and 44.50 (± 5.72) kg/m2. Of this group, 184 patients underwent RYGB and 191 banded RYGB. During follow-up (3 months, 1-5 years) % Total Weight Loss (%TWL) was superior in the banded group (32.6% vs 27.6% at 5 years post-operative, p < 0.001). Complication rates in both groups were similar. Comorbidity improvement or remission did not significantly differ between the two groups (p = 0.14-1.00). After 5 years of follow-up, 79 patients (20.5%) were lost to follow-up. CONCLUSION: Banded RYGB does show superior weight loss compared to non-banded RYGB. No difference in effect on comorbidity improvement or remission was observed. Since complication rates are similar, while weight loss is significantly greater, we recommend performing banded RYGB over non-banded RYGB.

Conversion of Adjustable Gastric Banding to Adjustable Banded Roux-en-Y Gastric Bypass: Should We Leave the Band in Place?

OBJECTIVE: Laparoscopic adjustable gastric banding (LAGB) is rapidly becoming a deprecated bariatric procedure due to disappointing weight loss results and a high rate of band intolerance. Conversion to Roux-en-Y gastric bypass is a common revisional procedure after failed LAGB. The aim of this study was to evaluate the feasibility, safety, and risk profile of conversion to adjustable banded Roux-en-Y gastric bypass (ABRYGB). METHODS: A retrospective patient file review of all consecutive laparoscopic conversions of LAGB to ABRYGB 2008-2017. Pre/perioperative data, weight change, and long-/short-term complications were retrieved. RESULTS: Study population 98 patients. Mean BMI before revision was 40,15 kg/m2. Most revisional procedures were performed for band intolerance and/or weight regain or weight loss failure. All procedures were performed laparoscopically. During follow-up, 16 bands had to be removed due to one of the following reasons: infection, anastomotic leakage, anastomotic peptic perforation, adhesions around the anastomosis, internal hernia around the tubing, adhesions to the tubing, tubing failure, and erosion of the band. Three of those bands were replaced with a non-adjustable Silastic (Minimizer) ring. In total, issues with tubing requiring an intervention were found in 20 patients after conversion to ABRYGB. Seven revisional procedures had to be performed for symptomatic internal hernias not related to the tubing and incidental internal hernias were found in another 7 procedures. CONCLUSION: Although conversion of LAGB to ABRYGB is technically feasible, initially well-tolerated, and has good weight loss results, the number of additional procedures during follow-up is rather high, suggesting that leaving the band in place should not be advised.