MiniMizer Ring Minimising weight regain – the Freiburg experience
How the MiniMizer Ring is helping to prevent post-operative weight regain by preventing sleeve dilatation
Although bariatric surgery has helped many obese patients to lose weight, a small proportion of patients does experience weight regain. There are numerous causes for this post-operative occurrence such as poor patient compliance. However, one cause that is becoming increasingly apparent is pouch (after gastric bypass) or sleeve (after a sleeve gastrectomy) dilatation. Bariatric News talked to Dr Jodok Matthias Fink, Centre for Metabolic and Obesity Surgery of the University of Freiburg, Germany, about how his centre prevents weight regain occurring and treats patients who experience weight regain.
“Previous studies estimated the rate of weight regain after sleeve gastrectomy around 10-15%. We see perhaps 2-3 patients per week who experience a relevant weight regain after sleeve gastrectomy. Most of these patients have not had their primary procedure done at our centre,” he explained. “We usually use a MiniMizer Ring during the primary procedure. If a ring is used as a secondary procedure with the aim to tackle weight regain, for example after a gastric bypass, you have to reshape the pouch and then insert the Ring. If you do not reshape the pouch then it will result in a stenosis, as you have wrapped a small Ring around a dilated pouch and you will have too much tissue inside the Ring. Therefore, we would rather place the MiniMizer Ring during a primary bypass or sleeve. We rather perform a conversion to RYGB reshaping the upper part of the former sleeve for failed sleeve gastrectomy with sleeve dilatation.”
The MiniMizer Ring (Bariatric Solutions) has been specially designed to prevent dilatation and is very easy to place and close, aided by a blunt, silicone covered introduction needle that simplifies retrogastric placement.
The MiniMizer Ring can be tailored to suit several closing positions from the largest to the smallest ring size: from 8.0 cm length (approx. 26mm internal diameter), to 7.5 cm length (approx. 24mm internal diameter, 7.0 cm length (approx. 22mm internal diameter) and 6.5 cm length (approx. 20mm internal diameter). This feature also allows for re-opening if the ring is either too tight or too loose.
Fink added that his centre performs approximately 30 procedures with the MiniMizer Ring a year (20 banded sleeves and 10 banded bypasses).
Jodok Matthias Fink
“We have not experienced any issues from breakage or re-opening with the MiniMizer,” said Fink. “One of the key advantages of the MiniMizer Ring is that the introducer makes it very easy to place and close. Even if you have to remove the Ring because there maybe stenosis or the patient is vomiting, removal is simple because there is very little scar formation around the ring.”
Although he said that the MiniMizer Ring has sufficient sizes, in his centre they always secure the device on the second largest size (7.5 cm) to avoid the risk of stenosis.
With regards to outcomes, Fink recently conducted a retrospective study of 25 patients who received a banded-sleeve gastrectomy (with the MiniMizer Ring) and compared them to 25 patients with the same bougie size who received a standard sleeve gastrectomy. The results showed a benefit in terms of weight loss for the MiniMizer patients already after two years, which he said was surprising, because generally differences are expected after three, four or five years after the procedure.
The Centre for Metabolic and Obesitiy surgery of the University of Freiburg around Professor Marjanovic, Drs Küsters and Fink has initiated a single-centre, prospective randomised study (Minimizer for Sleeve Optimization Study, MISO trial) to investigate whether the MiniMizer Ring does in fact prevent weight regain. To date, there are no examples in the literature of studies that have investigated patients who have had a banded sleeve procedure to non-banded patients on a radiological (MRI) basis. This study will examine whether patients do benefit from the MiniMizer Ring and whether the MiniMizer Ring does prevent sleeve dilation. The study, which will compare banded sleeve patients to non-banded patients was approved in January 2015, has so far recruited ten patients.
“Overall, I think the MiniMizer Ring has brought forward our standard bariatric procedures. However, there is insufficient or contradictory data to comprehensively conclude that the banded-bypass or sleeve procedures should be the preferred option,” concluded Fink. “I personally think that by incorporating the MiniMizer Ring with a bypass or sleeve procedure makes a difference but we will have to wait for the data from all these studies to be published before we will know for sure.”