Greater weight loss at 5 years following ring-augmented RYGB

Among patients who undergo primary Roux-en-Y gastric bypass (RYGB) to treat obesity, those whose surgery is augmented with a prefabricated gastric ring lose significantly more of their initial weight at 5 years, a matched cohort study has found.

The mean percent total weight loss (TWL) at 5 years after surgery was 31.5 percent in patients who received ring-augmented RYGB (raRYGB) vs 28 percent in those who received regular RYGB (mean difference, 3.59 percentage points, 95 percent confidence interval [CI], 2.09–5.09; p<0.01).

Patients who received raRYGB had more than a twofold likelihood of experiencing ≥25 percent TWL by year 5 vs matched patients treated with RYGB of similar limb lengths (79.1 percent vs 60.8 percent; odds ratio [OR], 2.45, 95 percent CI, 1.70–3.52; p<0.01).

The superior weight loss from raRYGB came with a risk of ring-related complications which “appears fairly low”, the authors noted. Only 4.4 percent of patients were affected after 5 years of follow-up. [Obes Surg 2025;doi:10.1007/s11695-025-07706-x]

“The additional risk of ring-related complications might be a fair trade-off to the number of patients who will be withheld from the need for secondary surgery for suboptimal clinical response,” said lead author Marijn Jense, a clinical researcher at the Department of Bariatric Surgery, Zuyderland Medical Center, Sittard-Geleen, the Netherlands. “Therefore, based on the current results, raRYGB can be considered a potent and safe option for standard practice.”

Weight recurrence

The gastric ring used at the study institution is a medical device specifically designed to be added to gastric bypass surgery or sleeve gastrectomy: a nonadjustable silicone ring placed loosely around the newly created gastric pouch in the context of RYGB. [BMC Surg 2020;20:122] This additional procedural step takes approximately 3–5 min. [Obes Surg 2014;24:1771-1792]

One of the novel findings from the current study, for which there was “only very limited literature available describing”, is the association between raRYGB and recurrent weight gain (RWG), defined as weight gain >30 percent from the initial weight loss. Within 5 years after surgery, 18.6 percent of patients treated with raRYGB vs 29.1 percent treated with RYGB ever experienced RWG. The 38-percent lower odds of RWG with raRYGB were statistically significant (OR, 0.62, 95 percent CI, 0.42–0.90; p=0.01).

In an exploratory analysis, the beneficial effect of raRYGB vs RYGB on reducing RWG may be driven by the 20 percent of patients with the highest RWG, in whom the amount of RWG was lower following ring placement.

“Performing raRYGB could reduce the chance of additional surgery,” Jense emphasized. “As RWG is difficult to treat and ring-related complications are limited, the augmentation of RYGB with a nonadjustable silicone ring should be seriously considered for standard practice.”

Balanced 296 matched pairs

After collecting data on all the patients who underwent RYGB at the Zuyderland Medical Center within a 2-year period from mid-2016, Jense and colleagues included 296 patients (median BMI 41.8 kg/m²) and propensity score-matched with 296 patients (median BMI 41.5 kg/m²) who underwent RYGB from the Dutch Audit for Treatment of Obesity (DATO), a mandatory national quality registry for metabolic bariatric surgery involving all bariatric centres in the Netherlands.

Patients included from DATO received regular RYGB during the same period and were preselected only if the biliopancreatic and alimentary limb lengths were within prespecified ranges, in order to match raRYGB recipients more closely in terms of intestinal limb lengths.