Ring Augmentation of the Roux-en-Y Gastric Bypass
A Propensity Score Matched Analysis of 5-Year Follow-Up Results
Marijn T.F. Jense (Maastricht University, Zuyderland Medical Centre)
Floris F.E. Bruinsma (Maastricht University, Dutch Institute for Clinical Auditing)
Simon W. Nienhuijs (Catharina Hospital, Dutch Institute for Clinical Auditing)
Ronald S.L. Liem (Groene Hart Hospital, Nederlandse Obesitas Kliniek)
Perla J. Marang-van de Mheen (TU Delft - Technology, Policy and Management)
Jan Willem M. Greve (Maastricht University)
Evert Jan G. Boerma (Nederlandse Obesitas Kliniek, Zuyderland Medical Centre)
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Abstract
Background
The ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.
Methods
All consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.
Results
In total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09–5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38–0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.
Conclusions
At 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.
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