• patients with BMI between 40 and 55
• accepts the intake of obligatory vitamin and mineral supplementation
• sweet eaters
• patients with heartburn

• BMI 45 to 55
• treatment of:
  – diabetes mellitus type 2
  – arterial hypertension
  – hyperlipoproteinemia
  – other related diseases
• redo surgery after other metabolic operations in patients with high compliance
• accepts obligatory supplementation of vitamins and minerals
• sweet eaters
• patients with heartburn after LSG

• very successful (70-90% of excess weight loss)
• operation for patients where restrictive procedures like Balloon, Banding
  and Sleeve Gastrectomies have failed
• operation for volume eaters
• operation for patients with heartburn
• no dumping syndrome

• irreversible change in the anatomy
• lifetime vitamins and minerals supplement after surgery
• ring related complications
• conventional upper  gastroscopy of duodenum and remnant stomach is not possible

Laparoscopic Banded Roux-en-Y Gastric Bypass reduces the size of the stomach through surgical stapling. This type of weight loss surgery cuts the stomach and leaves a reservoir approximately the size of a walnut. The pouch is created vertically and a small silastic ring between 19 and 23 mm in diameter placed on its end. Afterwards the biliopancreatic limb is measured (50 - 100cm) The distal intestines are connected to the stomach pouch (Gastro-Enteroanastomosis GEA). This causes the food to be directed immediately from the stomach to the jejunum. The small intestine junction called Jejuno-Jejunal Anastomosis (JJA) is created 100 – 150 cm from the GEA.

Besides its restrictive role, the ring contributes to the reduction of undesirable side effects like dumping syndrome, and foul flatulence. The Banded Bypass causes satiety and reduces caloric intake through retarding gastric emptying and inducing the satiation sensation even with low food intake. The silicone ring controls the diameter of the gastroenterostomy.

• Morphology
• Electrolytes
• Ferrum
• Creatinin
• Liver ferments
• Vitamins B1, B12-level
• HDL, LDL, VLDL, Chol
• Ferritin
• Transferrin
• Zinc
•  Magnesium
• 1,25-Dihydroxy-Vitamin D3
• Haemoglobin A1c

* after three and six months, then annually

• Calcium with Vitamin D3 2000 mg (with 130ug) per day
• Multivitamin + Minerals 1 tab. per day
• Fe+2 Iron 1 tab per day 30mg – one week long in a month, (3 weeks without the Ferrum)
• Protein 50g per day
• Vitamin B12 every 3 months i.m. (1000ug) or 25000 I.U. sublingual 2 times a week
• Vitamin B1 when needed
• Zinc  tab.15 mg per day
• Biotin, Selenium, Vitamin B9 (B11) daily for 3 months

PPI 20 mg, 0-0-1 (3 months)

• 3 weeks after operation – rest
• more than 3 hours of physical activity per week – sport
  medical supervision and medical advice required

The influence of the silastic ring on the percentage of excess weight loss within the first year was between 81.3 and 73.5%. After two years, the percentage ranged around 80%, and at 5-year follow-up an EWL of about 75% could be found.
Only a slight weight regain of 2.5% or 5% is observed between the second and fifth postoperative year, whereas a weight regain of over 10% in the same period is reported in LCRYGB.
The EWL after conventional GB reached 58.2% after five years in the best series. Bessler performed the first prospective study that directly compared the two operation methods.
After the second or third postoperative year, the patient seems to adapt to the surgery and suffers side-effects in lower intensity, which brings a tendency for a slight weight gain.. The weight gain is very slight compared to the conventional Gastric Bypass.

A team of experts must approve the surgery before BRYGB operation.
Because we promote safe practice and your safety is of paramount high importance to us and to you, the disadvantages and advantages of the different procedures will be carefully explained to you in detail on consultation.
In the preoperative period, you are provided with care from physicians, psychologists and nutritionists. This team of experts will give you accurate advice on all aspects of the postoperative period: What you can eat and drink, when and how often; what kind of exercises to perform; which individual therapy is necessary for specific issues related to your obesity.
You will have every opportunity to reduce your weight and improve your health. Just imagine the moment when you can wear size L clothes again. Discover your potential and improve your lifestyle. After surgery, you will normally lose approximately 50 kg in first 6 months, provided that you follow the nutrition plan, take exercise therapy and participate in scheduled group discussions.
Only if you are willing to change yourself you will achieve your goal, i.e. healthy weight loss. You must be aware that this will not always be easy. However, with every pound lost, you will win more quality of life, health and a longer life expectancy.