A functional Roux-en-Y gastric bypass to avoid gastric exclusion: 1-year results.
BACKGROUND
Roux-en-Y gastric bypass (RYGBP) is rarely performed in Italy because it involves gastric exclusion. RYGBP with the stomach partitioned by an adjustable gastric band has been previously described. We have developed a functional RYGBP (FRYGBP) where an adjustable band allows access from a stapled gastric bypass pouch into the distal stomach.


METHODS
From October 2001 to May 2002, 16 patients underwent FRYGBP. A 30-cc vertical gastric pouch was fashioned by a 25-mm circular and 90-mm four-row stapler as in the Mason VBG. A hand-sewn retrocolic gastroenterostomy with 150-cm Roux and 30-cm afferent limbs completed the operation. The pouch outlet was encircled distal to the gastrojejunostomy by a non-inflated adjustable gastric band. The bands were inflated at 1 month during barium swallow, to demonstrate occlusion of the gastro-gastric outlet and patency of the gastrojejunostomy.


RESULTS
There was no operative mortality. After 1 year, mean percent excess BMI loss (%EBMIL) was 71.2 +/- 16.2% (SD), and gastroscopy of the bypassed stomach was possible on 81% of the patients. There were three asymptomatic late complications (19%): two band erosions, converted to RYGBP, and one stenosis of the gastro-gastric outlet.


CONCLUSIONS
FRYGBP thus far has been effective and allows the study of the excluded stomach. This ongoing study will undergo long-term evaluation.
Cariani
Stefano
S
Dipartimento di Scienze Chirurgiche ed Anestesiologiche, Centro Studi di Terapia Chirurgica dell'Obesità Patologica, Università degli Studi di Bologna, Italy. stefanocariani@hotmail.com
Vittimberga
Giovanni
G
Grani
Sergio
S
Lucchi
Andrea
A
Guerra
Manuela
M
Amenta
Enrico
E
D000713:Anastomosis, Roux-en-Y; D016099:Endoscopy, Gastrointestinal; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D008297:Male; D011859:Radiography; D013272:Stomach Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome