Abstract
BACKGROUND: Suboptimal clinical response (SCR) after laparoscopic Roux-en-Y gastric bypass (RYGB) is often attributed to gastric pouch and gastrojejunostomy dilatation. Ring placement, which includes a ring to prevent pouch dilatation, may help reduce SCR. This study compared 3-year outcomes of ring-augmented (rRYGB) versus non-ring-augmented RYGB (nrRYGB). METHODS: A single-blinded, randomized controlled trial was conducted in two specialized bariatric centers, including 120 rRYGB and 120 nrRYGB patients operated on between January 2019 and March 2020. The primary endpoint was weight loss (WL), assessed by the percentage of excess weight loss (%EWL) and total weight loss (%TWL). Secondary endpoints included gastric pouch and gastrojejunostomy volumetry, complications, quality of life (QoL), food tolerance (FT), associated medical problems, and recurrent weight gain (RWG, > 20% of TWL). RESULTS: Ninety-two nrRYGB and 96 rRYGB patients completed the 3-year follow-up. Both groups achieved significant WL (p < 0.001); however, rRYGB had significantly higher %EWL and %TWL (p = 0.012, < 0.001) and lower RWG (p < 0.001). At 3 years, rRYGB had smaller gastric pouch volumes, narrower gastrojejunostomy diameters, and alimentary limb diameters (p < 0.001), with lower FT scores (p < 0.001) and incidence of dumping (p = 0.042). Both groups showed comparable QoL improvements and resolution of associated medical problems. CONCLUSION: rRYGB patients had better %EWL and %TWL and less recurrent weight gain. They maintained smaller volumes of the gastric pouches, smaller diameters of the gastrojejunostomy anastomoses and the alimentary limbs, and lower dumping after 3 years. The attribution of the ring could help patients in the long term in their postoperative period.