Post on 25-May-2015
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Banded Gastric Bypass
www.aacsh.com
A new development in the bypass aims to prevent long term weight regain by ensuring that the restriction to eating too much too fast is maintained.The procedure is called the banded gastric bypass. It is a simple addition to the bypass procedure and taked only a few minutes longer of operation time and confers minimal risk.
The surgeon will place a small ring or band around the top of the stomach pouch (see figure). The ring is designed to sit comfortably around the small new stomach without causing any compression. Therefore in the short term a patient with a ring will have exactly the same felling of restriction as a patient without a ring. The message is it is not restrictive.
The ring will start to work only in those patients who are at risk of regaining weight. These are patients who typically would have been quite big before surgery, typically BMI greater than 50kg/m2.
Once appetite returns and the honeymoon period of weight loss is over some patients start trying to overeat again. At first food may get partially stuck and things may be uncomfortable. However if this behaviour is continued then eventually the small stomach and the opening between the stomach and intestine will stretch.
Over time the whole of the upper stomach can dilate up to be able to accommodate a large volume of food in a short time. The designer of the first ring, an American surgeon called Mal Fobi, calls this the ‘hot dog stomach’ because these patients can consume a hot dog in a couple of minutes.
It is only in these patients who attempt to overeat that the ring has an effect. By sitting as a guard around the stomach. Not compressing it but preventing stretching and long term stomach dilation.
Results for studies comparing banded gastric bypass to standard gastric bypass do indeed show that there is a real and significant improvement in long term outcome with the ring band.