Italian multicenter experience of Roux-en-Y gastric bypass on vertical banded gastroplasty: four-year results of effective and safe innovative procedure enabling traditional endoscopic and radiographic study of bypassed stomach and biliary tract.

Background: Cancer, perforation, and bleeding in the bypassed stomach after Roux-en-Y gastric bypass (RYGB) are rare, but serious, complications that need an early diagnosis. Our goal was to perform gastric bypass such that traditional endoscopic and radiographic study of the gastric remnant would be possible and, at the same time, obtain results in terms of weight loss equivalent to those found after standard RYGB. A previously published study demonstrated that complete occlusion of the gastrogastric outlet was not necessary to lose weight. We have developed an open RYGB-on-vertical banded gastroplasty procedure.

Methods: Since 2002, 289 patients with a mean age of 40.1 +/- 14.8 years, mean body mass index of 51.4 +/- 7.3 kg/m(2), and mean percentage of excess body weight of 107.3% +/- 36.7% underwent RYGB-on-vertical banded gastroplasty as their primary procedure.

Results: The follow-up examinations included radiographic and, if necessary, endoscopic studies at 6 and 12 months postoperatively and annually thereafter. Two cases of anastomotic ulcer were detected, one of which involved band erosion. The percentage of excess weight loss was 48.2% +/- 18.8% after 6 months and 59.0% +/-17.7%, 63.3% +/- 13.9%, 66.9% +/- 17.5%, and 70.0% +/- 17.7% after 1, 2, 3, and 4 years, respectively. The weight loss curve was similar to that for standard RYGB.

Conclusion: The results of our study have shown that RYGB-on-vertical banded gastroplasty is as effective as traditional RYGB, while allowing for traditional radiography of the bypassed stomach in every patient. Endoscopy of the distal stomach and, therefore, the biliary tract, was also possible. These are the fundamental aspects of the procedure.