Primary banded RYGB, banded long-limb RYGB, and revisional B-RYGB: weight loss and complications at one-year follow-up

Abstract

Aim : We aimed to study the effectiveness and safety of primary banded Roux-en-Y gastric bypass (B-RYGB), primary banded long-limb RYGB (B-LLRYGB), and revisional B-RYGB to address insufficient post-RYGB excess weight loss (≤ 50.0%) or weight regain. Methods: This was a single-center, retrospective, comparative analysis of weight loss and postoperative complications in patients with class III obesity [body mass index (BMI, kg/m2) ≥ 40.0 - ≤ 50.0] who received the MIDCAL® non-adjustable calibration ring during primary B-RYGB or B-LLRYGB, or as part of a revisional banding procedure. Results: Between July 2017 and January 2021, the B-RYGB + B-LLRYGB cohort of 104 patients (median BMI 49.3 ± 4.6 [40.6-67.8]) achieved a mean BMI of 30.7 ± 4.8, total weight loss (TWL) 37.7% ± 7.9%, and excess BMI loss (EBMIL) of 77.5% ± 17.2% at 1-year follow-up (P < 0.001). One-year respective B-RYGB (n = 53) vs. B-LLRYGB (n = 51) analysis: mean BMI 29.4 ± 3.6 vs. 32.4 ± 5.4 (P < 0.005), TWL 38.0% ± 7.3% vs. 37.4% ± 8.6% (P = 0.746), EBMIL 80.7% ± 15.0% vs. 73.6% ± 18.9% (P = 0.066). The revisional B-RYGB cohort of 96 patients [baseline BMI 37.6 ± 5.5 (28.0-59.2)] attained a 1-year mean BMI of 31.7 ± 4.6, TWL 16.2% ± 9.7%, EBMIL 49.3%% ± 40.2% (P < 0.001). There was no mortality. 30-day complication rates: primary group 0.0%, revisional group 3.8%. Longer-term (median 577 days) complication rates: primary group 2.5%, revisional group 17.7%. Conclusions: At one-year follow-up in patients with class III and IV (≥ 50.0 - ≤ 60.0) obesity, B-RYGB, B-LLRYGB, and revisional B-RYGB were effective in attaining weight loss with a low rate of complications. Band-related complications were more frequent in revisions than in primary cases, likely due to the use of smaller-sized bands.