Since the introduction by Mason and Ito in 1966 of the loop gastric bypass, this procedure has proved consistently the most successful treatment for the greatest number of morbidly obese patients. It is also the most well researched bariatric operation, with more than 7.800 peer reviewed publications.
However, RYGB is also related to specific complications and long term weight regain. Over the years several modifications have been suggested to the RYGB of which the banded gastric bypass seems to be the most effective, with superior weight loss results and similar or even improved complication rates.
In the early 90’s Fobi and Capella were among the first to report the technique of banded gastric bypass, which by and large, is used until today.
Dr. Edward Mason
Dr. Mal Fobi
Many bariatric surgery techniques have come and gone since then, but the banded bypass has steadily built up an experience base demonstrating superior outcomes in terms of safety and effectiveness.
It is one of the few surgical bariatric techniques, which can show more than 15 year follow up data. Next to that, there currently are various randomized controlled trials in process which will be published in a couple of years.
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Fig. 1: Correlation between excess weight loss (EWL) and gastric pouch outlet diameter (DGPO) at second year of follow-up.
The RYGB promotes hormonal conditions most favorably providing an environment for the intrinsic loss and maintenance of weight. But this mechanism appears to be outweighed by the power of mechanical restriction. If the restriction is small, it can increase the chance of surgical failure, even in the presence of hormonal changes. If the restriction is excessive, it can cause complications. The RYGB even without ring presents a significant degree of restriction of food intake, but it seems to wear out over time.
This website will try to explain along the lines of evidence based medicine why we think banded gastric bypass is superior to the standard gastric bypass.
The basic principle of banding the bypass is to protect the stoma against overstretching AND to provide restriction to the patient when overeating.
Slower pouch emptying helps to maintain satiety for a longer time than in RYGB.