Roux-En-Y Gastric Bypass-On-Vertical Banded Gastroplasty: 6 Years of Experience of a Modified Gastric Bypass Which Allows Endoscopic and Radiological Investigation of the Excluded Stomach

Background The problem of definitive gastric exclusion after a conventional Gastric Bypass was overcome in 2002 with developing the technique of Roux-en-Y on Vertical Banded Gastroplasty (RYGB-on-VBG). In the short-term the procedure showed effectiveness, while leaving a gastro-gastric thin passage, wich allows the traditional radiography and endoscopy of the bypassed stomach. In this study the outcomes were evaluated after 6 years. Methods From June 2002 to February 2009, 268 patients, with mean age 41.8±11.5 years and mean BMI 48.0±8.3 kg/m2, underwent RYGB-on-VBG via an open approach. The preoperative comorbidities were hypertension (p. 112), hyperlipidemia (p. 98), OSAS (p. 56) and type II DM (p. 41). The follow-up was scheduled at 6 and 12 months and annually thereafter and consisted of clinical control, x-ray study with barium, and upper endoscopy if needed. Results The mean preoperative BMI decreased from 48.4±8.4 kg/m2 to 35.2±6.6, 32.4±5.8, 31.5±5.8, 31.5±7.4, 33.4±6.5 and 34.8±7.2 kg/m2 after 6 months and 1, 2, 3, 4and 5 years, respectively. The percentages resolution of comorbidities were: OSAS 89%; type II DM 83%; hypertension 45%; hyperlipidemia 30%. Early surgical complications were 4 (1.4%) and late were 5 (1.8%). In the follow-up, for every patient the study of the remnant with a barium swallow and/or a upper gastroscopy was possible. Conclusion The RYGB-on-VBG enables traditional diagnostic evaluation of the stomach, which is only functionally excluded. Weight loss, resolution of comorbidities and surgical complications of this procedure, at medium-term were comparable to those after standard RYGB.