Laparoscopic Banded Roux-en-Y Gastric Bypass (LBRYGB)

Functions of the Ring

Besides its restrictive role, the ring contributes to the reduction of undesirable side-effects like dumping syndrome, and foul flatulence. The banded bypass causes satiety and reduces caloric intake through retarding gastric emptying and inducing the satiation sensation even with low food intake. The silicone ring controls the diameter and area of the gastoenterostomy.

Indications for LBRYGB

• BMI 45 to 55
• Treatment of:
  • Diabetes Mellitus type II
  • arterial hypertension
  • other related diseases
• Redo surgery after other metabolic operations in patients with high compliance
• accepts obligatory supplementation of vitamins and minerals
• sweet eaters
• patients with heartburn

Advantages

• very successful (50-70% of excess weight loss)
• operation for patients who failed restrictive procedures like balloon, banding and sleeve gastrectomies
• operation for sweet eaters
• operation for patients with heartburn
• No dumping syndrome

Disadvantages

•  relatively high early complication rate (like dumping syndrome)
• mortality 0.5 – 2%
• Irreversible change in the anatomy
• life-time vitamins and minerals after surgery
• Ring-related complications
• Conventional upper gastroscopy of duodenum and remnant stomach is not possible

Operation Time

• The LBRYGB procedure takes between 1,5 - 2,5 Hours.

Technical description 

Laparoscopic Banded Roux-en-Y Gastric Bypass reduces the size of the stomach through surgical stapling. This type of weight loss surgery cuts the stomach and leaves a reservoir approximately the size of a walnut. The pouch is created vertically and a small silastic ring between 19 and 23 mm in diameter in its end. Afterwards the biliopancreatic limb is measured (50cm) The distal intestines are connected to the stomach pouch (Gastro-enteroanastomosis GEA) mostly with the round stapling method. This causes the food to be directed immediately from the stomach to the jejunum. The small intestine junction called jejuno- jejuno anastomosis (JJA) is created 120 - 150 cm from the GEA.

Hospitalisation Time

• The procedure requires a 4-to-7-night stay in the hospital after the operation.

After Surgery

After surgery, the patient must follow special diets and vitamin intake to lose weight in a controlled manner.

Weight loss differences

• The influence of the silastic ring on the percentage of excess weight loss within the first year was between 81.3 and 73.5. After two years, the percentage ranged around 80%, and at 5-year follow-up an EWL of about 75% could be found.
• Only a slight weight regain of 2.5% or 5% is observed between the second and fifth postoperative year, whereas a weight regain of over 10% in the same period is reported in LCRYGB.
• The EWL after conventional GB reached 58.2% after five years in the best series. Bessler performed the first prospective study that directly compared the two operation methods.
• After the second or third postoperative year, the patient seems to adapt to the surgery and to suffer its side-effects in lower intensity, which brings a tendency for some recovery of lost weight. But weight gain is very slight compared to the conventional gastric bypass.

 Lab Tests after LBRYGB:

• Morphology¹
• Electrolytes¹
• Ferrum¹
• Creatinin
• Liver ferments¹
• Vitamins B1, B12-level¹
• HDL, LDL, VLDL, Chol².
• Ferritin^2,3
• Transferrin^2,3
• Zink^2,3
• Magnesium²
• 1,25-Dihydroxy-Vitamin D3^2,3
• Haemoglobin A1c²

1. 1 Mo, 3 Mo, 6 Mo, yearly 
2. 6 Mo, 1 year 
3. yearly

Supplementation after LBRYGB:

Bariatric Analysis and Reporting Outcome Score – BAROS 

• Once a year

Standard Medication after Operation

• PPI 20mg, 0-0-1 (3 Months)

Sport and physical activity

• Three weeks after operation
• 3 hours of physical activity per week but under sport medical supervision and medical advice.

Diet after LBRYGB