Long-Term Outcomes of Pouch Resizing with Ring Augmentation for Dumping Syndrome and Weight Trajectory after Roux-en-Y Gastric Bypass: A Single-Center Experience.

INTRODUCTION: Dumping syndrome (DS) and recurrent weight gain are among the most relevant long-term challenges following Roux-en-Y gastric bypass (RYGB). Several treatment strategies have been proposed, including pouch resizing with ring augmentation (PRRA). This study presents long-term outcomes of PRRA, with a focus on weight trajectory and the management of DS symptoms. METHODS: A retrospective analysis of all PRRA procedures performed at a tertiary referral center between January 2008 and September 2023. Clinical data were obtained from electronic health records and patient questionnaires. RESULTS: Sixty-two patients (90.3 % female, mean age at time of RYGB 40.2 ± 9.5 years, mean BMI 47.4 ± 7.9 kg/m2) underwent PRRA at a mean interval of 56.3 ± 34.6 months after RYGB. DS was the leading indication (74.2 %), followed by recurrent weight gain (24.2 %) and primary suboptimal clinical response (1.6%). Following PRRA, 62.8 % of patients (n = 45) reported long-term improvement in DS-related symptoms, and 79 % (n = 57) achieved renewed weight loss. Long-term weight stabilization was observed, with only modest recurrent weight gain (+2.1± 5.4 kg/m2from post-PRRA nadir weight) after a mean follow-up of 48.6± 40.0 months. Ring removal was required in 25.8 % of patients, predominantly due to dysphagia and regurgitation. CONCLUSIONS: PRRA is an effective revisional option for managing DS symptoms after RYGB and contributes to sustained weight stability in patients with recurrent weight gain. However, ring-related adverse effects may necessitate removal in a subset of patients.