Obesity Surgery

, Volume 19, Issue 5, pp 650–654 | Cite as

Laparoscopic Placement of Non-Adjustable Silicone Ring for Weight Regain After Roux-en-Y Gastric Bypass

  • Giovanni DapriEmail author
  • Guy Bernard Cadière
  • Jacques Himpens
Research Article



Roux-en-Y gastric bypass (RYGBP) is presently one of the most popular surgical procedures for obesity. One of the possible long-term problems is weight regain, usually after a period of successful weight loss. Weight regain after RYGBP can be due to new eating habits, like sweet-eating or grazing, or volume eating because of impaired restriction. This paper reports our experience in patients who presented weight regain after laparoscopic RYGBP, because of new appearance of volume eating or hyperphagia, treated by the laparoscopic placement of a non-adjustable silicone ring around the gastric pouch.


From July 2004 to November 2007, six patients affected by weight regain due to hyperphagic behavior, benefited from revision of RYGBP consisting of the placement of a non-adjustable silicone ring loosely encircling the stomach part. Mean weight and body mass index (BMI) at the time of RYGBP were 105.0 kg ± 12.3 and 36.3 ± 3.0 kg/m2, respectively, and all patients suffered from obesity-related co-morbidities. After a mean time from RYGBP of 26.0 ± 14.2 months, patients presented a weight regain of 4.7 ± 3.4 kg compared with their minimal weight, with a final mean weight, BMI, and percentage of excess weight loss (%EWL) at the time of the silicone ring of 86.0 ± 13.1 kg, 29.5 ± 3.9 kg/m2, and 47.0 ± 24.7%, respectively. Preoperative evaluation for each patient included history and physical examination, nutritional and psychiatric evaluation, laboratory tests, and barium swallow check. Outcome measures included evaluation of the Roux-en-Y construction, operative time, postoperative morbidity and mortality, and weight loss in terms of absolute weight loss, BMI, and %EWL.


Any modification of the digestive circuit was evidenced. Mean operative time was 82.5 ± 18.3 min. No operative mortality and no conversion to open surgery were achieved. No postoperative complications were achieved. Mean hospital stay was 2.6 ± 1.5 days. After a mean follow-up of 14.0 ± 9.2 months, the six patients presented a mean weight loss of 9.1 ± 2.4 kg, with a final mean weight, BMI, and %EWL of 76.8 ± 13.7 kg, 26.4 ± 4.2 kg/m2, and 70.4 ± 30.4%, respectively. Difference in term of %EWL before and after revision (23.4 ± 5.7) is statistically significant (p < 0.05). There have been no erosions or slippage of the ring during this follow-up.


One of the possible causes of weight regain after RYGBP is the new eating behavior of the patient, one of which is hyperphagia. Treatment of this condition can be the placement of a non-adjustable silicone ring loosely fitted around the gastric pouch which contributes to improved weight loss.


Weight regain Gastric bypass Failure Revision Eating behavior 


  1. 1.
    Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967;47:1345–51.CrossRefGoogle Scholar
  2. 2.
    Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg. 1994;4:353–7.CrossRefGoogle Scholar
  3. 3.
    DeMaria EJ, Schauer PP, Patterson E, et al. The optimal surgical management of the superobese patients: the debate. Surg Innov. 2005;12:107–21.CrossRefGoogle Scholar
  4. 4.
    Pories W, Swanson M, MacDonald K. Who would have thought it ? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;22:39–50.Google Scholar
  5. 5.
    Jones K. Experience with Roux-en-Y gastric bypass, and commentary on current trends. Obes Surg. 2000;10:183–5.CrossRefGoogle Scholar
  6. 6.
    White S, Brooks E, Jurikova L, et al. Long-term outcomes after gastric bypass. Obes Surg. 2005;15:155–63.CrossRefGoogle Scholar
  7. 7.
    Himpens J, Cremer M, Cadière GB, et al. Use of a new endoluminal device in the transoral endoscopic surgical procedure for the treatment of weight regain after Roux-en-Y gastric bypass. Presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), April 18–22, 2007, Dallas TX (US).Google Scholar
  8. 8.
    Mikami DJ, Needleman B, Happel L, et al. Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after Roux-en-Y gastric bypass. Presented at the 11th World Congress of Endoscopic Surgery (WCES), September 2–5, 2008, Yokohama (Japan).Google Scholar
  9. 9.
    Thompson CC, Slattery J, Bundga ME, et al. Peroral endoscopic reduction of dilated gastrojejunal anastomosis after Roux-en-Y gastric bypass: a possible new option for patients with weight regain. Surg Endosc. 2006;20:1744–8.CrossRefGoogle Scholar
  10. 10.
    Torquati A, Kernodle SS, Kaiser JI, Attwell AR. Transoral revision of dilated gastro-jejunostomy anastomosis after gastric bypass surgery. Abstract Surg Obes Relat Dis. 2008;4:306.CrossRefGoogle Scholar
  11. 11.
    Mullady DK, Lautz DB, Thompson CC. Treatment of weight regain following gastric bypass surgery using a novel endoscopic device: technical feasibility and early outcomes in twenty patients. Poster at the Annual Meeting of the Digestive Disease Week (DDW), May 17–22, 2008, San Diego CA (US).Google Scholar
  12. 12.
    Herron DM, Birkett DH, Thompson CC, et al. Gastric bypass pouch and stoma reduction using a transoral endoscopic anchor placement system: a feasibility study. Surg Endosc. 2008;22:1093–9.CrossRefGoogle Scholar
  13. 13.
    Thompson CC. Techniques of stenting for leaks and gastro-gastric fistulae. Presented at the Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), June 15–20, 2008, Washington DC (US).Google Scholar
  14. 14.
    Fobi MAL, Lee H, Igwe D Jr, et al. Revision of failed gastric bypass to distal Roux-en-Y gastric bypass: a review of 65 cases. Obes Surg. 2001;11:190–5.CrossRefGoogle Scholar
  15. 15.
    Sugerman HJ, Kellum JM, De Maria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1:517–25.CrossRefGoogle Scholar
  16. 16.
    Fobi MAL. Why the operation I prefer is silastic ring vertical gastric bypass. Obes Surg. 1991;1:423–6.CrossRefGoogle Scholar
  17. 17.
    Faria SL, de Oliveira Kelly E, Lins RD, et al. Nutritional management of weight regain after bariatric surgery. Obes Surg. 2008;Jun 25 (Epub ahead of print).Google Scholar
  18. 18.
    Fobi MAL. Placement of the GaBP ring system in the banded gastric bypass operation. Obes Surg. 2005;15:1196–1201.CrossRefGoogle Scholar
  19. 19.
    Bessler M, Daud A, Kim T, et al. Prospective randomized trial of banded versus nonbanded gastric bypass for the super obese: early results. Surg Obes Relat Dis. 2007;3:480–5.CrossRefGoogle Scholar
  20. 20.
    Bessler M, Doud A, DiGiorgi MF, et al. Adjustable gastric banding as a revisional baraitric procedure after failed gastric bypass. Obes Surg. 2005;15:1443–8.CrossRefGoogle Scholar
  21. 21.
    Gobble RM, Parikh MS, Greives MR, et al. Gastric banding as a salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass. Surg Endosc. 2008;22:1019–22.CrossRefGoogle Scholar
  22. 22.
    Chin PL, Ali M, Francis K, LePort PC. Adjustable gastric band placed around gastric bypass pouch as revision operation for failed gastric bypass. Surg Obes Relat Dis. 2009;5:38–42.CrossRefGoogle Scholar
  23. 23.
    Bessler M, Daud A, Inabnet WB, Schrope B. Adjustable gastric banding as a revisional bariatric procedure after failed gastric bypass—intermediate results. Abstract Surg Obes Relat Dis. 2008;4:310.CrossRefGoogle Scholar
  24. 24.
    O’Brien PE, Dixon JB, Laurie C, et al. A prospective randomized trial of placement of the laparoscopic adjustable gastric band: comparison of the perigastric and pars flaccida pathways. Obes Surg. 2005;15:820–6.CrossRefGoogle Scholar
  25. 25.
    Z’graggen K, Guweidhi A, Steffen R, et al. Severe recurrent hypoglycemia after gastric bypass surgery. Obes Surg. 2008;18:981–8.CrossRefGoogle Scholar
  26. 26.
    Silecchia G, Bacci V, Bacci S, et al. Reoperation after laparoscopic adjustable gastric banding: analysis of a cohort of 500 patients with long-term follow-up. Surg Obes Relat Dis. 2008;4:430–6.CrossRefGoogle Scholar
  27. 27.
    Fobi MAL, Lee H, Igwe D, et al. Band erosion: incidence, etiology, management and outcome after banded vertical gastric bypass. Obes Surg. 2001;11:699–707.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Giovanni Dapri
    • 1
    Email author
  • Guy Bernard Cadière
    • 1
  • Jacques Himpens
    • 1
  1. 1.Department of Gastrointestinal Surgery, European School of Laparoscopic SurgerySaint-Pierre University HospitalBrusselsBelgium

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