Today, we are going to discuss an interesting topic that is why and how banded procedures or how the use of a band or ring in bariatric surgery is beneficial? Most people confuse a banded gastric bypass or a banded sleeve or the use of a ring in bariatric or metabolic surgery with the old band. The old band used earlier was called the adjustable gastric band. This adjustable band is now obsolete. Thus, we will be talking about the banded gastric bypass and the banded sleeve or the use of a pre-sterilised, pre-fabricated, pre-sized ring made up of silicon, which is not adjustable in the bariatric surgery. This band has been in use for the last 8 – 10 years to prevent weight regain post-bariatric surgery.

Hence, in present times, we do not use the old, adjustable gastric band. Instead, we use a pre-sterilised, pre-fabricated silicon ring which is pre-calibrated and fixed. This ring is then put over the pouch of the stomach after reducing its size. This procedure is known as a banded gastric bypass when a small-sized Fobi-pouch is made and bypassed and the ring is placed 2.5 centimetres above the anastomosis. The sample principle can be applied to a sleeve gastrectomy whereupon, we put a ring 2-4 centimetres below the gastroesophageal junction, on a sleeve to prevent weight regain. Most of the studies, which have been published, have clearly shown that sleeve gastrectomy has 5-15% of weight regain while in some studies, around 25-30% of weight regain can also be seen after 5 years of performing the sleeve gastrectomy. The data from our centre suggests that at 5 years we have almost a 50% weight loss failure where less than 50% of these patients have maintained their weight and greater than 50% of access weight loss after a sleeve gastrectomy.

How to manage?

How do we manage the weight regain, the weight recidivism, after bariatric surgery in both, sleeves and gastric bypass? We came up with the solution of putting this particular ring on the sleeve and the gastric bypass. The data, publications, and most of the international papers from highly reputed journals published by leaders like Dr. Mal Fobi, Prof. Brookwood, Dr. Luke Newman, and many others across the world have suggested that adding a ring to a gastric bypass or a sleeve have long term results, whereupon the weight is maintained at a very long period in these set of patients. The underlying reason for this is very simple – the capacity of the stomach is being reduced by applying laparoscopic staplers and a small pouch or sleeve is made which dilates with time. This dilatation or enlargement of the stomach happens because the smooth muscles of the stomach enlarge with time which in turn, increases the reservoir capacity of the pouch or the sleeve which we make. Slowly, these patients complain, “we were having a limited diet initially but as the time has progressed, our diet has increased, and the quantity of food has increased.” Somehow, these patients feel cheated because the amount of food they are consuming gradually increases. When the amount or quantity of food increases, they start to regain weight, diabetes comes back again, they have a raised blood glucose level, snoring and sleep apnoea resumes, problems with the lipids in the blood start again, where the LDL cholesterol increases and the HDL cholesterol increases and the triglycerides in the blood increases. All such problems, comorbidities that were sorted previously, slowly start to come back with the increase in weight as the time after the bariatric surgery goes by.

The process with the banded procedures is different. Our data suggest that 5-to 7 years, the patients who have undergone a banded procedure, that is, they got a pre-sterilised, pre-fixed, pre-calibrated silicone ring on their pouch and got a banded gastric bypass or banded sleeve done at our centre or centres across the world, have maintained their weight at until 10 years and have got progressive weight loss. The problem with the banded procedure is minor, which is nausea and vomiting for few patients who have a food intolerance. This problem happens only in 5% of the patients who do not comply with the food and dietary pieces of advice given by us. However, this problem can be cured very easily and readily by reassurance and diet counselling. There is less than a 2% rate of ring erosion which can be managed easily by endoscopic procedures, without any surgery. Thus, in all, we have a 95-98% of success rate without weight regain or minimal regain with banded procedures.

Hence, all those of you who are looking forward to a long-term weight regain of 10 years and sustained and healthy weight loss which is also accompanied by loss of all comorbidities like diabetes, hypertension, sleep apnoea, deranged lipids, and if you are looking forward to a long overhaul with bariatric surgery, a long weight loss durability, my advice to you would be that please choose banded procedures as they have long term data for sustained weight loss.

Thank you.

Author: mbohra

Mohit Bhandari is a renowned Indian bariatric surgeon and globally recognized for his contribution in Laparoscopic and Robotic surgeries.

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