"Band over Bypass" a Viable Option for People Struggling after a Gastric Bypass.

In a recent issue of Surgery for Obesity and Related Diseases (Jan-Feb 2010) Marc Bessler, MD from Columbia University in New York reported on his group’s experience of placing an adjustable gastric band over the gastric pouch from a previous gastric bypass.

In this article Dr. Bessler said, “We report on 22 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an adjustable silastic gastric band around the proximal gastric pouch.”

The results showed a 47.3% loss of excess weight at 2 years and if you compared their weight with the weight they had before either operation they lost a total of 59.4%

My experience is that most patients that see me in consultation who have not done well after a gastric bypass operation have fallen into one or more of the following situations:

1). They have gone to a location where the program is not very robust and has not helped them to get their best result.
2). They were not well prepared for their operation psychologically and/or nutritionally.
3). They were operated on with a very high BMI and did not lose weight before the operation to reach a BMI of 55 where they are more likely to have a better long term result.

Although it is unfortunate that these patients did not do as well as expected with their gastric bypass operation, the technique of “band over bypass” appears to be the best option at this time.

Other revisions such as changing the length of the small intestine, reduction of the size of the gastric pouch or decrease in the size outlet of the gastric pouch, (call the stoma), with the use of an endoscope have not shown to benefit patients significantly long term.

I have a friend from California who is an attorney that helps people of size gain access to bariatric surgery who has personally done very well with the “Band over Bypass” option and is very pleased with his results.

I believe “Band over Bypass” is the best option presently available for these patients and is not that difficult to perform. Hopefully this technique will help persons of size who continue to struggle despite a gastric bypass operation.

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