Weight Regain After A Gastric Bypass? Put A Band On It!
Dr Rudolf Steffen is a bariatric and metabolic surgeon at the Hirslanden Klinik Beau-Site in Bern, Switzerland, one of the leading centres in the country for bariatric and metabolic surgery. Since 2003, he has performed more than 3,000 banded bypass operations.
“The reasons why patients experience weight regain two years after a gastric bypass is because it is a restrictive operation and if the restriction fails, the patients regain weight,” began Professor Steffen. “In our experience, 29% of 404 patients in the fourth year after unbanded bypass required a pouch revision with a band for weight regain because of loss of restriction. Percentages increasing thereafter.
As a result, he recommends banded bypass to all his bypass patients who are suitable for the procedure, after explaining the advantages and disadvantages of the procedure and he informs them that in his opinion, there is good, but limited data. He also recommends a banded bypass for revision procedures, primarily for those patients who received a gastric band in the mid 90’s.
“I explain that approximately 50% of patients will probably not need one but there is no way to know who these patients are,” he added. “In addition, I tell them that about half of all bypass patients will need a reoperation due to a loss of restriction. It is important to give our patients as much information as possible so they can make an informed decision. Some patients may not like the idea of having a foreign body inside them, so they just have a bypass.”
He said that he does not perform many sleeve gastrectomies (20 or so a year), as he do not want a restriction in the same location where a leak might occur and explained that he views the sleeve as a high-resistance tube, so in the first instance it does not require a band.
“However, a banded sleeve can be considered in a secondary case, but in such cases I usually convert the sleeve to a bypass.”
Professor Steffen said that it is important to understand the mechanisms of a banded bypass and many people are under the misapprehension that the goal of a banded bypass is to make people lose more weight. He clarified this by stating that the goal of the banded bypass is not to regain weight, which has been demonstrated in several multi-centres studies that showed after two or three years, the non-banded patients reported more weight regain.
“If a bariatric surgeon chooses not to place a ring, in my opinion, it is justified because we do not have the long-term data yet from prospective, randomised clinical trials,” he concluded. “However, in my experience it is of benefit to explain the procedure to gastric bypass patients. The ring can always be placed in a revision procedure if the patient has weight regain or presents with hyperglycaemia.