Banded gastric bypass is basically applying a ‘ring’ to the gastric/stomach ‘pouch’.
Why we do banded gastric bypass?
People starts gaining weight at about 3 years after they had gastric bypass. This is because the stomach ‘pouch’ starts stretching with time and with that the ‘stoma’ or the join between the stomach pouch and the small intestine and finally the small intestine just beyond the stoma or gastrojejunal anastomosis.
To prevent this stretching of the stoma and therefore the rest of the small intestine, the ring is placed just proximal to the stoma /gastrojejunal anastomosis. By doing so the stomach pouch size is not changed but the stoma size will be the same unless the ‘band’ or ‘ring’ erodes through into the stomach. This erosion of the band can happen in about 2 % of patients over 10 years. If it happens, the restriction is gone from the band and band has to be removed using a camera (gastroscopy) into the stomach.
The results over 5-10 years seems to be good. The weight loss is maintained at the 3 year level itselv which could be around 70% of their excess weight. Various authors already have presented their experience. I will show a couple.
Two types of ‘rings’ are available –
‘Fobi’ Ring and ‘Minimiser’ band and many more are coming into the market as many surgeons are realising that they have to do something about the durability of the effect of gastric bypass.
Once the gastric pouch stretches, then there are few options one is left with. Reducing the stomach pouch size or lengthening the alimentary limb seems not to work in majority of the cases. Banding the gastric pouch is effective but not as good as one does it primarily at the time of the original operation of gastric bypass. If there is a doubt, it is better to band it from the beginning. Of course there is small chance of erosion of the band/ring into the stomach.