Pouch Revision in Combination with Placement of a MiniMizer Ring as a Revisional Procedure in Patient with Suboptimal Clinical Response or Recurrent Weight Gain After RYGB

Background and ObjectivesBariatric surgery, in particular Roux-en-Y gastric bypass (RYGB), has been a well proven and effective means of long-term management of severe obesity. However, about 10-35% of patients have a suboptimal clinical response (lowest quartile of weight loss after RYGB surgery) or suffer from recurrent weight gain often resulting in additional surgery. This study investigates the short-term results on weight loss and complications of surgical revision of the pouch in combination with placement of a MiniMizer ring in patients with a suboptimal clinical response or recurrent weight gain after RYGB.MethodsAll patients who underwent pouch revision in combination with placement of a MiniMizer ring in the Zuyderland Medical Center between January 2016 and December 2021 were included. Weight, obesity-related complication resolution, and complications were monitored and reported during the follow-up appointments at the Nederlandse Obesitas Kliniek up to 2 years post-revisional surgery.ResultsThirty-six patients were included. These patients had a mean %TWL of 12.3 and 13.5 at 12 and 24 months post-revisional surgery. This resulted in a cumulative %TWL of 28.7 at 24 months after the revisional procedure. Patients with a superior response after the primary RYGB procedure (%TWL >= 35) responded better in %TWL post-revisional surgery compared to patients with a suboptimal response after the primary RYGB with a cumulative %TWL of 33.9 and 17.5 respectively. One ring-related complication occurred.ConclusionsPouch revision in combination with placement of a MiniMizer ring appears to be a promising approach for managing patients with a suboptimal clinical response or recurrent weight gain after RYGB. The procedure offers significant additional weight loss with a low complication rate.