Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results

Marijn T.F. Jense; Floris F.E. Bruinsma; Simon W. Nienhuijs; Ronald S.L. Liem; Perla J. Marang-van de Mheen; Jan Willem M. Greve; Evert Jan G. Boerma

doi:10.1007/s11695-025-07706-x

Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results

Marijn T.F. Jense^*, Floris F.E. Bruinsma, Simon W. Nienhuijs, Ronald S.L. Liem, Perla J. Marang-van de Mheen, Jan Willem M. Greve, Evert Jan G. Boerma

^*Corresponding author for this work

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Abstract

Background
The ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.

Methods
All consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.

Results
In total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09–5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38–0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.

Conclusions
At 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.

Original language	English
Article number	e13607
Pages (from-to)	884-893
Number of pages	10
Journal	Obesity Surgery
Volume	35
DOIs	https://doi.org/10.1007/s11695-025-07706-x
Publication status	Published - 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Banded bypass
Real-world data
Recurrent weight gain
Ring augmentation
Ring augmented gastric bypass
Ring augmented Roux-en-Y gastric bypass

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10.1007/s11695-025-07706-x

s11695-025-07706-xFinal published version, 1.02 MBLicence: CC BY

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@article{7f001c95f37640d881f8be5fa7906f00,

title = "Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results",

abstract = "BackgroundThe ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.MethodsAll consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.ResultsIn total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09–5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38–0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.ConclusionsAt 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.",

keywords = "Banded bypass, Real-world data, Recurrent weight gain, Ring augmentation, Ring augmented gastric bypass, Ring augmented Roux-en-Y gastric bypass",

author = "Jense, {Marijn T.F.} and Bruinsma, {Floris F.E.} and Nienhuijs, {Simon W.} and Liem, {Ronald S.L.} and {Marang-van de Mheen}, {Perla J.} and Greve, {Jan Willem M.} and Boerma, {Evert Jan G.}",

year = "2025",

doi = "10.1007/s11695-025-07706-x",

language = "English",

volume = "35",

pages = "884--893",

journal = "Obesity Surgery",

issn = "0960-8923",

publisher = "Springer",

}

TY - JOUR

T1 - Ring Augmentation of the Roux-en-Y Gastric Bypass

T2 - A Propensity Score Matched Analysis of 5-Year Follow-Up Results

AU - Jense, Marijn T.F.

AU - Bruinsma, Floris F.E.

AU - Nienhuijs, Simon W.

AU - Liem, Ronald S.L.

AU - Marang-van de Mheen, Perla J.

AU - Greve, Jan Willem M.

AU - Boerma, Evert Jan G.

PY - 2025

Y1 - 2025

N2 - BackgroundThe ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.MethodsAll consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.ResultsIn total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09–5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38–0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.ConclusionsAt 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.

AB - BackgroundThe ring-augmented Roux-en-Y gastric bypass (raRYGB) has been reported to result in higher long-term weight loss compared to regular Roux-en-Y gastric bypass (RYGB). However, the type of ring used varied within studies, leading to heterogeneity in reported results. Therefore, this study compares the 5-year results of RYGB with and without ring augmentation using a specific prefabricated gastric ring.MethodsAll consecutive patients from a single center who received primary raRYGB between June 1, 2016, and May 31, 2018, with complete 5-year follow-up data were included and compared to a propensity score matched cohort receiving RYGB in the same period from the Dutch Audit for Treatment of Obesity. To ensure fair effect estimation of placing a ring, only RYGB procedures with alimentary and biliopancreatic limb lengths similar to those of the raRYGB were considered eligible. The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included recurrent weight gain (RWG), obesity complication improvement, and complications.ResultsIn total, 592 matched patients were analyzed. raRYGB was associated with higher %TWL at 5 years (31.5% versus 28.0%, β = 3.59, 95% CI [2.09–5.09], p < 0.01) and lower odds on RWG (odds ratio = 0.56, 95% CI [0.38–0.83], p < 0.01). Improvement of obesity complications and short-term complication rates were comparable in both groups. After 5 years, 13 patients (4%) had experienced ring-related complications needing reoperation.ConclusionsAt 5 years, raRYGB was associated with higher %TWL and lower odds on RWG. The occurrence of ring-related complications was limited.

KW - Banded bypass

KW - Real-world data

KW - Recurrent weight gain

KW - Ring augmentation

KW - Ring augmented gastric bypass

KW - Ring augmented Roux-en-Y gastric bypass

UR - http://www.scopus.com/inward/record.url?scp=85217218908&partnerID=8YFLogxK

U2 - 10.1007/s11695-025-07706-x

DO - 10.1007/s11695-025-07706-x

M3 - Article

AN - SCOPUS:85217218908

SN - 0960-8923

VL - 35

SP - 884

EP - 893

JO - Obesity Surgery

JF - Obesity Surgery

M1 - e13607

ER -

Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results

Abstract

UN SDGs

Keywords

Access to Document

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Correction to: Ring Augmentation of the Roux-en-Y Gastric Bypass: A Propensity Score Matched Analysis of 5-Year Follow-Up Results (Obesity Surgery, (2025), 10.1007/s11695-025-07706-x)

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