The Banded Gastric Bypass

Banded gastric bypass is a modification which enhances the restrictive component of the gastric bypass operation. A reinforced stoma is created by placing a band around the pouch, as in the vertical banded or silastic ring vertical gastroplasty. The gastroenterostomy (GE) is made just distal to the band. This GE is made at least 2 cm wide since – unlike in the non-banded gastric bypass – the banded stoma, not the gastroenterostomy, controls the outflow from the pouch. The stabilized and reinforced stoma has been documented to effect more weight loss even in the super obese and better weight loss maintenance in more patients than the non-banded gastric bypass. The stoma created in the banded gastric bypass is larger than in the gastroplasty operations. The perioperative and long-term complications are as reported with the short-limb gastric bypass. Since the gastroenterostomy is made wider there is a lesser incidence of outlet stenosis requiring endoscopic dilation, but there is a 2% incidence of band erosion. Eroded bands can be treated expectantly or can be removed with an endoscope. In patients with an intact operation but inadequate weight loss or some weight regain the bypass can be modified to a banded distal Roux-en-Y gastric bypass (BDRYGB).