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.

BACKGROUND: Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. METHOD: Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. RESULTS: The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75%, respectively, in the NR group vs. 75.4 and 1.1, and 24.4% in the WR group. The mean QOL score was 79% in the NR group vs. 80% in the WR group. CONCLUSION: After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.

An evaluation by rat colon anastomosis of the efficacy of fibrin glue derived from snake venom

The objective of this study was to evaluate the efficacy of fibrin adhesive made up of snake venom and bubaline fibrinogen by rat colon anastomosis. Eighty rats were randomly assigned into 2 experimental groups: GI control (anastomosis with extramucous interrupted suture) and GII (repair suture + fibrin glue). The animals were studied at the following 4 times: T0 - preoperative - T1 - 7th day postoperative, T2 - 14th day postoperative, and T3 - 21th day postoperative. The macroscopic characteristics of the intestinal segment open and closed anastomosis and the bursting strength of the anastomosed segments were observed at each of the above times. The results showed that the anastomosed segments coapted and there was no difference in the bursting strength values between the 2 groups. There was a decrease in the bursting strength values up until de 7th day postoperative in both groups with its progressive increase at the other times. Although important experimental studies using large animals are needed for a better evaluation of tissue repair processes, this adhesive may become a valuable tool for use in anastomosis.