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

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. 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. 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. 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. PRRA reduces dumping syndrome severity and frequency long term. PRRA supports renewed weight loss and long-term stability after RYGB weight regain. Ring retention is high; despite adverse effects overall tolerability is favorable. PRRA is a reversible revisional option with sustained clinical effectiveness.