A Comparative, Prospective and Randomized Evaluation of Roux-en-Y Gastric Bypass With and Without the Silastic Ring: A 2-Year Follow Up Preliminary Report on Weight Loss and Quality of Life

Effect of Gastric Bypass vs Sleeve Gastrectomy on Remission of Type 2 Diabetes Mellitus Among Patients with Severe Obesity: A Meta-Analysis

BACKGROUND

Obesity and type 2 diabetes mellitus (T2DM) are global health crises, with bariatric surgery emerging as a key intervention. However, the comparative efficacy of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) in achieving diabetes remission remains debated.

METHODS

This PRISMA-compliant meta-analysis included three randomized controlled trials (RCTs, n = 613 patients) comparing RYGB and SG in adults with severe obesity (BMI ≥30 kg/m²) and T2DM.

PRIMARY OUTCOME

diabetes remission (HbA1c 6.0%). Risk of bias was assessed via Cochrane RoB-2 tool; statistical analysis used fixed-effect models (I²=0%).

RESULTS

RYGB demonstrated superior diabetes remission rates vs. SG (OR 2.77, 95% CI 1.83-4.20, p0.001), with no heterogeneity. Subgroup analyses confirmed consistency across studies. Mean follow-up was ≤5 years; baseline demographics were comparable (mean age 46.2 years, 53.4% male).

CONCLUSION

RYGB significantly outperforms SG in achieving T2DM remission, likely due to its combined restrictivemalabsorptive mechanisms and metabolic hormonal effects. These findings support RYGB as the preferred surgical option for obese patients with T2DM, though long-term studies are needed to assess durability.

Five-year outcomes of a randomized controlled trial evaluating a non-adjustable ring in Roux-en-Y gastric bypass

BACKGROUND

Several retrospective studies suggest that adding a non-adjustable silicone ring to a Roux-en-Y gastric bypass (RYGB) results in more weight loss and prevents weight regain in the long term. The aim of this study was to evaluate the effect of a banded Roux-en-Y gastric bypass (B-RYGB) on weight loss outcomes in a randomized controlled trial (RCT).

METHODS

In this single center RCT, 130 patients were divided into two groups: a standard Roux-en-Y gastric bypass (S-RYGB) or a B-RYGB using a Minimizer® ring. Subsequently, weight loss, morbidity, reduction of obesity-associated medical conditions, quality of life (QoL), and complication rates were measured during a follow-up period of five years. A two-sided p < 0.05 (with 95% confidence interval) indicated statistical significance.

RESULTS

After five years, mean percentage total body weight loss (%TBWL) was 30.5% in the S-RYGB versus 31.8% in the B-RYGB group (p > 0.05). The follow-up percentage was 81%. Overall, no significant differences in complication rates, resolution of obesity-associated medical conditions, and QoL were found between the two groups. In the B-RYGB group, 8 (12%) silicone rings were removed due to symptoms of dysphagia.

CONCLUSION

B-RYGB is a safe procedure showing similar comorbidity when compared to a S-RYGB. However, B-RYGB led to a higher rate of postoperative dysphagia which poses a risk of ring removal over time. The results from this RCT do not support the hypothesis that implantation of a non-adjustable silicone ring improves long-term weight loss outcomes.

Banded versus non-banded Roux-en-Y gastric bypass: short, mid, and long-term surgical outcomes - a systematic review and meta-analysis

BACKGROUND

The Roux-en-Y gastric bypass (RYGB) is considered as one of the most effective treatments for people with obesity. A variant of this procedure, the banded-RYGB, may present several advantages over the standard technique. These potential benefits include enhanced weight loss, decreased recurrent weight gain, a lower incidence of dumping syndrome, and less distention of the jejunum below the gastrojejunostomy.

OBJECTIVES

The objective of this meta-analysis is to compare the surgical outcomes of RYGB procedures with a band (banded-RYGB) and without a band (RYGB) in the management of individuals with obesity.

SETTING

A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane protocol (PROSPERO ID: CRD42023439874).

METHOD

The systematic review process led to the identification of 13 comparative studies involving 3230 patients who underwent banded-RYGB and 5302 who received RYGB, all of which were eligible for inclusion and meta-analysis.

RESULTS

Four studies reported data on 1-year postoperative percent excess weight loss (%EWL), demonstrating a significant increase of 6.03 %EWL in patients who underwent banded-RYGB. Four studies reported the 2-year postoperative %EWL, showing that patients who had banded-RYGB experienced a 5.32 greater %EWL compared to those who received RYGB, even if this was not statistically significant. For 5-year %EWL after bariatric surgery, 5 studies were included for continuous outcome meta-analysis. The average 5-years %EWL difference was 7.6 in favor of banded-RYGB. Patients who had banded-RYGB presented a nonsignificant 1.45 OR of developing postoperative complications compared to patients receiving RYGB.

CONCLUSION

This meta-analysis demonstrates that, compared to RYGB, patients who underwent banded-RYGB surgery showed a statistically significant increase in the %EWL at 1, 2, and 5 years postoperatively. Moreover, the banding procedure does not significantly increase the risk of postoperative complications.

Banded Versus Non-banded Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Standard bariatric surgeries include biliopancreatic diversion (BPD), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB). Laparoscopic sleeve gastrectomy (LSG) is currently favored due to safety, efficacy, and shorter operation time. However, previous literature shows 75.6% weight regain post LSG. Introducing Laparoscopic band sleeve gastrectomy (LBSG) to maintain pouch size is proposed to improve outcomes and reduce weight regain. This study aims to compare the safety and efficacy of LSG vs. LBSG in obese patients. A comprehensive search strategy was executed to identify pertinent literature comparing LBSG and LSG in obese patients. Eligible studies underwent independent screening, and pertinent data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI). Our systematic review and meta-analysis included 15 studies encompassing 3929 patients. Regarding body mass index (BMI), at six, 12, and 24 months, no substantial differences were found between LBSG and LSG groups (p < 0.05). Still, at 36 months, LBSG exhibited significantly lower BMI than LSG (MD = -2.07 [-3.84, -0.29], p = 0.02). Excess Weight Loss (EWL) favored LBSG at 12, 24, and 36 months with MD of 3.30 [0.42, 6.18], 4.13 [1.44, 6.81], and 18.43 [9.44, 27.42], p = 0.02, 0.003, < 0.00001, respectively). Operative time did not significantly differ between the procedures (MD = 2.95, 95%CI [-0.06, 5.95], p = 0.05). Resolution of comorbidities, overall complications, post-operative bleeding, reflux, and early complications did not significantly differ between LBSG and LSG. However, LBSG showed higher post-operative regurgitation than LSG (RR = 2.38, 95%CI [1.25, 4.54], p = 0.008). LBSG showed a substantial decrease in BMI at three-year follow-up and higher EWL at one, two, and three years. However, LBSG procedures exhibited a higher incidence of post-operative regurgitation symptoms than LSG. No substantial differences were noted in BMI at six, 12, or 24 months, EWL at six months, operative time, bleeding, reflux, or overall complications.

Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial

OBJECTIVE

To determine whether silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) or laparoscopic sleeve gastrectomy (LSG) produces superior diabetes remission at 5 years.

RESEARCH DESIGN AND METHODS

In a single-center, double-blind trial, 114 adults with type 2 diabetes and BMI 35-65 kg/m2 were randomly assigned to SR-LRYGB or LSG (1:1; stratified by age-group, BMI group, ethnicity, diabetes duration, and insulin therapy) using a web-based service. Diabetes and other metabolic medications were adjusted according to a prespecified protocol. The primary outcome was diabetes remission assessed at 5 years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications. Secondary outcomes included changes in weight, cardiometabolic risk factors, quality of life, and adverse events.

RESULTS

Diabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (adjusted odds ratios 4.5 [95% CI 1.6, 15.5; P = 0.009] and 4.2 [1.3, 13.4; P = 0.015] in the intention-to-treat analysis). Percent body weight loss was greater after SR-LRYGB than after LSG (absolute difference 10.7%; 95% CI 7.3, 14.0; P < 0.001). Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB. Early and late complications were similar in both groups. General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB. People of Māori or Pacific ethnicity (26%) had lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83; P < 0.001).

CONCLUSIONS

SR-LRYGB provided superior diabetes remission and weight loss compared with LSG at 5 years, with similar low risks of complications.

From the Knife to the Endoscope-a History of Bariatric Surgery

PURPOSE OF REVIEW

Current bariatric surgical practice has developed from early procedures, some of which are no longer routinely performed. This review highlights how surgical practice in this area has developed over time.

RECENT FINDINGS

This review outlines early procedures including jejuno-colic and jejuno-ileal bypass, initial experience with gastric bypass, vertical banded gastroplasty and biliopancreatic diversion with or without duodenal switch. The role laparoscopy has played in the widespread utilization of surgery for treatment of obesity will be described, as will the development of procedures which form the mainstay of current bariatric surgical practice including gastric bypass, sleeve gastrectomy and adjustable gastric banding. Endoscopic therapies for the treatment of obesity will be described. By outlining how bariatric surgical practice has developed over time, this review will help practicing surgeons understand how individual procedures have evolved and also provide insight into potential future developments in this field.

Multiple concurrent complications of Roux-en-Y gastric bypass with MiniMizer gastric ring-alimentary limb intussusception through slipped ring into pouch, with remnant stomach internal herniation

Roux-en-Y gastric bypass (RYGB) is the second most common bariatric procedure performed in Australia, second to sleeve gastrectomy. Banding of pouches and anastomoses, via silastic bands or MiniMizer rings, have been used to assist in improving restriction. Though banded gastric bypasses are effective in weight loss, band migration, whether it be slippage or erosion, occurs in up to 7% of banded bariatric procedures. Jejunal intussusception and internal herniation are both individually known complications of RYGB. It is, however, rare to have all three phenomenon occur in a single patient. In this study, the authors present a report of a middle-aged lady, 2 years post-primary RYGB with MiniMizer gastric ring insertion presenting with all three complications.

Ongoing Inconsistencies in Weight Loss Reporting Following Bariatric Surgery: a Systematic Review

Weight loss is the primary outcome following bariatric surgery; however, its documentation within current literature is heterogeneous and poorly defined, limiting meaningful comparison between studies. Randomized controlled trials from 2012 to 2016 were identified using the Medline database through "Gastric bypass OR sleeve gastrectomy AND weight" search terms. A total of 73 studies with 5948 patients were included. Reporting of preoperative weight was done primarily using mean body mass index (BMI) (87.7%) and mean weight (65.8%). Postoperative weight reporting was more variable, with the most frequently reported measure being mean postoperative BMI (71.2%). Overall, nearly one third of all bariatric literature contained discrepancies that precluded meaningful meta-analysis. Reporting of weight loss following bariatric surgery is becoming increasingly diverse for both pre- and post-operative outcomes. Ongoing heterogeneity will continue to act as a barrier to meaningful comparison of bariatric outcomes until standardized reporting practices become adopted.

Weight Loss and Vomiting 1 Year After Banded Versus Non-banded One Anastomosis Gastric Bypass: a Prospective Randomized Trial

BACKGROUND

The weight loss outcomes after banded one-anastomosis gastric bypass (OAGB) remain to be determined.

OBJECTIVE

To compare weight loss and vomiting 1 year after banded versus non-banded OAGB.

METHODS

This is a prospective, open-label, randomized study, which evaluated 33 individuals with morbid obesity, which underwent banded (16 individuals) and non-banded OAGB (17 individuals) and were followed up for 12 months. Weight loss (percentages of total weight loss-%TWL-and excess weight loss-%EWL) and occurrence of vomiting were assessed and compared before surgery and after 6 and 12 months.

RESULTS

At baseline, there were no differences between groups in regard to age, gender, and body mass index (BMI). At 6 and 12 months post-op, and the overall mean %TWL regardless of band use was 22.4 ± 7% and 29 ± 6.9%, respectively, and the overall average %EWL regardless of band use was 66.8 ± 22.9% and 86.3 ± 24%, respectively. %TWL did not differ between the banded and non-banded groups at 6 (21.8 ± 6.8% vs. 23.1 ± 7.4%; p = 0.7) and 12 months post-op (27.5 ± 6.6% vs. 30.4 ± 7.1%; p = 0.3), as well as %EWL at 6 (67 ± 22.9% vs. 67.6 ± 23.6%; p = 0.6) and 12 months post-op (83.5 ± 24.4% vs. 89 ± 24.1%; p = 0.4). The occurrence of vomiting did not significantly differ between banded and non-banded OAGB at 6 (12.5% vs. 11.8%; p = 0.9) and 12 months post-op (12.5% vs. 5.9%; p = 0.5).

CONCLUSION

OAGB led to an overall satisfactory weight loss after 1 year, regardless of band use. Banded OAGB did not lead to neither significantly higher weight loss nor more vomiting than non-banded OAGB 1 year after surgery.

Gastric Emptying and Food Tolerance Following Banded and Non-banded Roux-en-Y Gastric Bypass

INTRODUCTION

Gastric emptying (GE) and food tolerance (FT) can be altered after Roux-en-Y gastric bypass (RYGB) has been performed, especially when it involved the use of a restrictive mechanism (such as a silastic ring).

AIM

To assess GE and FT in patients who underwent banded (BRYGB) or non-banded Roux-en-Y gastric bypass (RYGB).

METHODS

Forty-seven BRYGB patients and 47 RYGB patients underwent gastric emptying scintigraphy (GES) and FT assessment (by means of a questionnaire) between 6 months and 2 years postoperatively.

RESULTS

GES was performed on average 11.7 ± 5.0 months (6 to 24) postoperatively. T½ medians (time taken for the gastric radioactivity to decrease to half of the original value in the gastric pouch) in the RYGB and BRYGB groups were 48.7 min (40.6-183.0 min) and 56.3 min (41.1-390.9 min), respectively (p = 0.031). The median of total questionnaire scores was 24 points (18-27) in the RYGB group and 20 points (13-27) in the BRYBG group (p < 0.001).

CONCLUSIONS

The band (silastic ring) delays GE time and does not affect patient satisfaction or food tolerance to vegetables, bread, or rice, but does affect tolerance to the intake of meat, salad, and pasta. The best tolerated foods are vegetables, salad, and fish. Banded patients are more likely to regurgitate and vomit. Gastric emptying does not affect FT.

Banded versus nonbanded Roux-en-Y gastric bypass: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Bariatric surgery is remarkably effective in achieving weight loss and improving obesity-related co-morbidities; however, efforts still continue to improve its long-term outcomes. Particularly, banded Roux-en-Y gastric bypass (RYGB) has been scrutinized in comparison to standard (nonbanded) RYGB in terms of benefits and postoperative complications.

OBJECTIVES

This study aims to compare the safety and efficacy of banded versus nonbanded RYGB.

SETTING

Meta-analysis of randomized controlled trials (RCTs).

METHODS

A meta-analysis of high-quality studies that compared banded and nonbanded RYGB was conducted through February 2019 by systematically searching multiple electronic databases. Published RCTs comparing these 2 procedures were included to pool the data on excess weight loss, food tolerability, and postoperative complications.

RESULTS

Three RCTs were eligible to be included in this meta-analysis, comprising a total of 494 patients (247 in each group). Two of the RCTs provided 2-year postoperative data, and 1 study reported 5-year outcome. Age ranged from 21 to 50 years, and body mass index ranged from 42 to 65 kg/m². Percentage of excess weight loss was significantly greater with banded RYGB than with nonbanded RYGB (mean difference 5.63%; 95% CI 3.26-8.00; P < .05). Postoperative food intolerance, emesis, and dysphagia were more common after banded RYGB (odds ratio 3.76; 95% CI 2.27-6.24; P < .001). Nevertheless, major postoperative complications did not significantly differ between the 2 groups.

CONCLUSION

Findings of this meta-analysis of RCTs indicate that in a medium-term follow-up, excess weight loss with banded RYGB would be 5% greater than that with the nonbanded RYGB (about 1 point difference in body mass index) at the expense of more food intolerance and postoperative vomiting; however, the frequency of postoperative complications would not be significantly different.

Influence of Energy Balance on the Rate of Weight Loss Throughout One Year of Roux-en-Y Gastric Bypass: a Doubly Labeled Water Study

OBJECTIVE

To investigate the influence of changes in energy balance and body composition on the rate of weight loss throughout 1 year of Roux-en-Y gastric bypass.

METHODS

Variables were collected pre-, 6, and 12 months (M) post-surgery from 18 women (BMI ≥ 40 and ≤ 50 kg m^-2, 20 to 45 years). Total energy expenditure (TEE_m), fat-free mass (FFM), and fat mass (FM) were measured by doubly labeled water. Self-reported energy intake (EI_sr) was obtained from three non-consecutive food diaries. Metabolic adaptation was assessed via deviations from TEE predictive equation, and the calculated energy intake (EI_c) via the sum of TEE and change in body stores.

RESULTS

BMI significantly decreased (mean ± SD) from 45 ± 2 kg m^-2 to 32 ± 3 kg m^-2 at 6 M, and to 30 ± 3 kg m^-2 at 12 M after surgery. The TEE_m reduced significantly at both time points when compared with pre-surgery (6 M: - 612 ± 317 kcal day^-1; 12 M: - 447 ± 516 kcal day^-1). At 6 M, a metabolic adaptation was observed and the energy balance was - 1151 ± 195 kcal day^-1, while at 12 M it was - 332 ± 158 kcal day^-1. Changes in the values of TEE_m were associated with changes in body weight at 12 M post-surgery. A significant underreporting was observed for EI_sr (1057 ± 385 kcal day^-1) vs. EI_c (2083 ± 309 kcal day^-1) at 12 M post-operative.

CONCLUSION

The higher rate of weight loss at 6 M post-surgery was a response to energy imbalance, which was caused by high restriction in energy intake even with the presence of metabolic adaptation at this time. The EI_sr was not sufficiently accurate to assess the energy consumption of this population.

REGISTRATION OF CLINICAL TRIALS (OBSERVATIONAL STUDY)

Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.

Banded vs. non-banded Roux-en-Y gastric bypass for morbid obesity: a systematic review and meta-analysis

We aim to review the available literature on patients with morbid obesity treated with banded (BRYGB) or non-banded Roux-en-Y gastric bypass (NBRYGB), in order to compare the clinical outcomes and intraoperative parameters of the two methods. A systematic literature search was performed in PubMed, Cochrane library and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 3899 patients. This study reveals similar rates of complications, mortality, remission of type 2 diabetes, hypertension, dyslipidaemia, gastroesophageal reflux and obstructive sleep apnoea, along with similar % excess weight loss (%EWL) at 1 and 2 years postoperatively. In contrast, according to an analysis of two eligible studies the BRYGB procedure was associated with increased %EWL at 5 years postoperatively. These results should be interpreted with caution due to the small number of statistical arms and randomized controlled studies. However, the present article represents the best available evidence in the field. Well-designed, randomized controlled studies, comparing BRYGB to NBRYGB, are necessary to further assess their clinical outcomes.

Laparoscopic Silastic Ring Mini-Gastric Bypass (SR-MGBP): Up to 11-Year Results from a Single Centre

BACKGROUND

Bariatric surgery is well established as an effective method for treating obesity and its related comorbidities. The laparoscopic mini-gastric bypass (MGBP) represents a simpler alternative to a Roux-en-Y gastric bypass (RYGBP). The placement of a silastic ring (SR) may enhance excess weight loss and minimize weight regain. This study reports long-term results from a cohort of patients undergoing a SR-MGBP in a single centre.

METHODS

Long-term outcomes (up to 11 years) in a cohort of 156 patients undergoing surgery between August 2005 and January 2008 were analysed. A combination of follow-up questionnaires and electronic hospital records were used to assess weight loss, comorbidity resolution and complications.

RESULTS

A total of 156 patients (mean body mass index 46 kg/m²) underwent surgery. Ninety-two patients responded to the follow-up questionnaires. Computer-based hospital information was available on a total of 139 patients. Mean percent excess weight loss (%EWL) at 11 years was 84.3%. Comorbidity resolution, determined by medication use, showed a reduction in diabetes (21.8% to 7.1%), hypertension (37.2% to 21.4%) and hypercholesterolaemia (40.4% to 13.4%). Five of 139 patients (3.6%) had SR problems needing removal. Two other patients had the SR changed to a bigger size and a further two had endoscopic removal of the SR for erosion. Of the 139 patients, 9.4% required conversion to a Roux-en-Y gastric bypass (RYGBP). The number of patients on anti-reflux medications increased from 5.1% to 44.6% at 11 years. There were two deaths unrelated to surgery.

CONCLUSIONS

SR-MGBP appears to be a safe and effective operation for the morbidly obese. It is durable, with good weight loss at up to 11 years post-surgery. The SR can easily be removed or exchanged for another size and is reasonable to consider when performing a MGBP. Concerns about bile reflux appear to be well founded, and some patients who are poorly controlled medically will require revision.

Postoperative Outcomes of Laparoscopic Bariatric Surgery in Older Obese Patients: a Matched Case-Control Study

BACKGROUND

Laparoscopic bariatric surgery (LBS) in older obese patients remains debated regarding postoperative outcomes.

OBJECTIVES

The aim of this case-control study is to evaluate global results of LBS in patients ≥60 years (yr) with a matched case control study.

METHODS

All patients ≥60 years who benefited from LBS in our center between January 2009 and January 2014 were included in this retrospective study. They were matched (1:2) to patients <40 and 40-59 years on BMI, surgical procedure and year, and history of previous LBS. Postoperative complications in the first 90 days following LBS, micronutrient and mineral deficiencies, and Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed.

RESULTS

Fifty-five patients ≥60 year (40 sleeve gastrectomy, 14 one anastomosis gastric bypass, 1 gastric bypass revision) were matched to patients <40 year and patients 40-59 year (n = 55 each). Patients ≥60 year presented more obesity-related comorbidities at baseline. Except for bleeding complications (P = 0.01), no difference in major complication rate was observed (P = 0.43). At 24 months, %EWL was lower in older patients compared to others (76.3, 82.2 and 89.7, respectively, P = 0.009). Iron and vitamin B12 deficiencies were less prevalent in patients ≥60 year After a mean follow-up of 27 months, BAROS score (filled in by 82% of patients) was lower in patients ≥60 years (P = 0.01).

CONCLUSION

Despite less weight loss, postoperative complications rate, and lower BAROS results, LBS keeps an acceptable benefit-risk balance in selected older patients and should not be rejected on the sole argument of age. Additional studies are needed to assess the long-term benefits of LBS in older patients.

Endoscopic Management of Eroded Bands Following Banded-Gastric Bypass (with Video)

BACKGROUND

Banded-gastric bypass is a highly effective bariatric procedure, yet the possibility of band erosion remains a significant drawback. Surgical removal of eroded bands may be associated with significant morbidity. In this study, we assess the efficacy and safety of a solely peroral endoscopic approach for the management of eroded bands in patients with a banded-gastric bypass.

MATERIALS AND METHODS

Starting January 2012, all patients with banded-gastric bypass and an eroded band were subjected to an attempt at peroral endoscopic removal using endoscopic scissors and/or argon plasma coagulation (APC), regardless of the circumference of band eroding inside the lumen.

RESULTS

Sixteen patients presented with eroded bands, 2 were deemed not amenable to endoscopic removal as only part of the thickness was eroded. Of the 14 patients where endoscopic attempts were performed, 12 (86%) were completely removed successfully, while 2 (14%) were cut but could not be extracted and only the intraluminal portion was trimmed. Complete resolution of symptoms occurred in 13 (93%) while in 1 patient (7%) there was partial improvement. Only one endoscopic session was performed per patient with a median time of 37.5 min per session (22-55 min). No complications were encountered.

CONCLUSION

Endoscopic removal of eroded gastric bands in patients with banded-gastric bypass is effective and safe in the majority of patients. When bands are adherent to the gastric wall, removal of the intraluminal portion of the band may lead to full or partial improvement of symptoms. Endoscopic band removal can be attempted even when a small part of band circumference has eroded.

Innovative solutions in bariatric surgery

Nowadays all over the world the rising plague of obesity can be observed. The obesity was recognized as "an epidemic of XXI century" in 1997 by World Health Organization. The change of eating habits, active lifestyle or pharmacological curation are often insufficient to fight against obesity. Nowadays, there are not any guidelines about gold standard for curing obese patients is bariatric surgery. At the moment, two types of bariatric procedures: laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, are most commonly used. There are also some other new approaches, which are still being investigated. The mechanism of losing weight in bariatric surgery is based on restriction, malabsorption and neurohormonal effect. Not only is the surgery technique very important to succeed, but also the postoperative care in the outpatient clinic. This article reviews the new possibilities in obesity treatment.