Revision of band to Bypass is frequently performed for either complications of the band or weight regain. This paper is a prospective analysis of patients converted to banded RYGB from AGB.
The Objectives of this study are to explore:
1. The safety and Complications of adding a fixed ring to the Gastric Pouch
2. Examine whether there is a subset of band patients that do best when a fixed ring is added to the gastric pouch.
3. Assess QOL
This a prospective study recruiting 158 patients over a 24 month period.
80 patients had Esophageal Dilatation as a reason for revision, 46 failure to lose weight and 32 patients for complications such as Slip and erosion
All Patients underwent Laparoscopic RYGB at a minimum 3 months post removal of their Band. A Minimiser ring was placed 2 cms above the gastrojejunostomy and tightened to either 7.5 cms or 7 cms over a 36 french bougie.
Patients with Esophageal dilatation did best losing on average 84% Excess weight, Patients who failed to lose weight did worst losing 49% Excess weight. Patients with complications of their band lost 76% of their Excess weight.
There were no complications. 1 band required removal due to reflux symptoms.
QOL was reported as good to excellent in all patients.
We conclude that adding a fixed ring to the gastric pouch with RYGB is a safe and efficacious. The fixed ring shows greatest promise in patients with a dilated distal esophagus. This may reflect the fact that restriction has become a normal part of their eating behaviours and adding a component of mild restriction to the gastric pouch may be of benefit to this subset of patients.