Chapter 26

The banded gastric bypass (BGBP), also known as a silastic ringed gastric bypass, is a combination of a Roux-en-Y GBP and a vertical banded or ringed gastroplasty. The procedure involves inclusion of a ring or band proximal to the gastrojejunostomy to simulate the pylorus and assist in restriction of stoma enlargement. The long-term weight loss success of patients who have had the banded or silastic ringed GBP suggests that the procedure may be more effective in weight-loss maintenance than the GBP alone. However, there are currently no long-term, randomized comparative studies of the benefits or complications of the banded versus nonbanded GBP procedures.

This chapter discusses (1) the evolution of the BGBP to its more common form, the laparoscopic banded or ringed transected GBP, (2) our technique and that of others in inclusion of the restrictive band or ring to the GBP, (3) complications associated with BGBP and the treatment or prevention, thereof, and (4) data available pertaining to the procedure's effectiveness in the short and long-term maintenance of weight loss.

Prosthetic devices have been used in bariatric operations to control the outlet of the gastric pouch for maintenance of weight loss for more than a quarter of a century. Mason,1 for instance, improved the efficacy of gastroplasty through the use of a band that restricted the outflow of food from the pouch and increased feelings of satiety. The procedure was known as the vertical banded gastroplasty (VBG) and was found in a short-term study1 (1 year) to be as effective in inducing weight loss as the GBP. Based upon these early observations, a number of surgeons abandoned the GBP for the less invasive VBG procedure. Longer-term comparative studies2–4 (2 and 3 years postoperatively) of the two procedures showed that the VBG, over time, produced significantly less weight loss than did the GBP and the rate of recidivism of the VBG was considerably higher. Many bariatric practices, thereafter, abandoned the VBG and converted any failed VBG surgeries to GBP.

The BGBP evolved out of such conversions. In the process of converting the VBG to a GBP, the removal of the mesh band proved technically difficult. In most instances, the original band had to be left intact, requiring that the gastroenterostomy anastomosis be constructed distal to the band. The initial BGBP was, therefore, a VBG containing a malabsorptive component.5

Fobi was among the first to recognize that BGBP produces superior weight loss to that of the nonbanded GBP procedure.5,6 At the 1988 meetings of the American Society for Bariatric Surgery, Fobi presented data showing that VBG–GBP conversion patients not only have superior weight loss to primary nonbanded GBP patients but also demonstrate significantly greater long-term (5 years or more) weight-loss maintenance. Other investigators7 confirmed these findings and found that excess weight loss with the VBG–GBP is comparable to that of more malabsorptive procedures, such as the biliopancreatic ...

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