title: Ring influence on ponderal evolution after four years of laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Use of ring in Roux-en-Y gastric bypass is still a matter of controversy among bariatric surgeons. There is no consensus on its impact in relation to weight loss and weight maintenance in the long term.
  
  
  OBJECTIVE
  To evaluate the influence of the ring on the evolution of body weight over four years after bariatric surgery.
  
  
  METHODS
  Retrospective analyzis of 143 women who underwent laparoscopic Roux-en-Y gastric bypass paired on the use or not use of Silastic® ring. Follow-up time was 48 months. Inclusion criteria were age over 18 years, primary bariatric operation and regular attendance at the clinic during the period of interest for research. The technique kept small gastric reservoir estimated in a volume of 30 ml. The food limb had in average 150 cm and the bile one 40 cm from the duodenojejunal angle. The group "ring" used Silastic® device with length of 6.5 cm, placed 2 cm from gastrojejunal anastomosis. The ring was closed for five polypropylene surgical thread sutures. In the morning after surgery the patients received isotonic fluids; on the second day salty liquid diet and were discharged on the third day. Semisolid diet started from the 20th day and solid on the 30th, with daily tablet of polivitamins.
  
  
  RESULTS
  The weight loss was larger on the ring than without ring groups in all periods, respectively 10% and only 5% in the third postoperative year. The proportion of not having reached the 50% excess weight loss expectative was significantly higher in the group without ring than in the group with the ring (31% and 8% respectively in the fourth year). There was no difference between groups in delayed recovery of weight lost with the operation.
  
  
  CONCLUSIONS
  The results were favorable to use the ring exclusively when it is analyzed only the weight loss.
authors: Clínica Bariátrica, Hospital Fornecedores de Cana, Piracicaba, SP. irineu@bariatrica.com.br
authors: Irineu
authors: I
authors: Rasera-Junior
authors: Natalia Moreno
authors: NM
authors: Gaino
authors: Maria Rita Marques de
authors: MR
authors: Oliveira
authors: Patrícia Fátima Sousa
authors: PF
authors: Novais
authors: Celso Vieira de Souza
authors: CV
authors: Leite
authors: Maria Aparecida Coelho de Arruda
authors: MA
authors: Henri
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D015431:Weight Loss