1. The GaBP Ring Device For Banding The Pouch in Gastric Bypass and Sleeve Gastrectomy Operations Bariatec Corporation P.O Box 4257 Palos Verdes Peninsula, CA 90274 1 562 809 1020 www.bariatec.com

2. GaBP Ring The GaBP Ring is a prefabricated, caliberated and sterilized silicone coated implantable device that is designed specifically to control the reservoir capacity in gastric operation for obesity.

3. The Gastric Bypass operation is the Gold standard of weight loss operations

4. Reports show that 15- 25% of patients do not achieve successful * weight loss in the short term 1-3yrs after the operation. Reports also show that this rate increases to 25-40% in patients followed longer than three years because of weight regain. *Successful weight loss; > 50% excess weight loss and or attainment of a BMI<35. The inadequate weight loss and weight regain observed in the gastric bypass operation have been attributed mostly to the increase in the gastric reservoir size due to dilation of the pouch, stoma and the proximal small bowel.

5. Reservoir size change with time Non-banded Roux-en-Y GBP Post op >3 yrs post op

6. Reservoir size change with time GaBP Ring Banded Gastric Bypass Post Op> 3 yrs Post op

7. Non Banded Gastric bypass Dilated stoma converts the pouch and the proximal small bowel into a neo-pouch that can accommodate as much as the initial Stomach. Causing inadequate weight loss and weight regain after gastric bypass Non Banded dilated Stoma and proximal Small bowel become part of neopouch

8. GaBP Ring Device Placement of a prosthetic device around the pouch to function as the stoma has been shown to not only reduce the pouch size but also to prevent the development of this large gastric reservoir.

9. Banding the pouch Banding the pouch creates a smaller pouch Banding the pouch minimizes pouch dilatation

10. GaBP Ring Banded Gastric Bypass

11. The Ring controls the Reservoir size in the gastric bypass operation The Ring controls the Reservoir size in the gastric bypass operation GaBP Ring Band Gastrojejunostomy Anastomosis Proximal Pouch 10-20 cc Interposing Limb of Jejunum used as a Serosal Patch Fobi et al World J.S 1998;22:925-35

12. GaBP Ring Device Reports have shown increased eight loss in more patients and less weight regain with the prevention of the formation of this large gastric reservoir. Since Roux-en-Y Gastric Bypass is primarily a restriction operation, just as with VBG, it is important that the outlet of the pouch does not stretch. ( E.Mason. Obesity Surgery 1994;4:66-72)

13. Based on these reports, MacLean in 1997 stated that: The most promising technique based on a large series at this time is that described by Capella and Capella Banded Gastric Bypass MacLean J Am Coll Surg 97;185:1-7

14. Banding the Gastric Bypass Operation Fisher after an in depth review concluded in 1999 that: Long-term results suggest that a silastic ring encircling the stomach pouch proximal to the gastroenterostomy may improve the outcome following gastric bypass surgery, resulting in more weight loss by a greater number of patients sustained for a longer time Fisher BL, Barber AE, Eur J Gastroenterol Hepatol 1999; 11:93-97

15. P EWL for standard RYGBP and its two hybrid forms of LL-RYGBP and B-RYGBP (* P < 0.05). [OBrien P.E:Systemic review of mdium term-weight loss after bariatric surgery; Obesity Surgery:2006;16;1032-40] In a systemic review, banded gastric bypass resulted in more weight loss and better weight loss maintenance

16. Banded Gastric Bypass Prospective comparative evaluation of the Laparoscopically banded gastric bypass vs. the Laparoscopically non-banded gastric bypass in the super obese. Marc Bressler, SOARD, July/August 2007 LAP Banded GBP Lap Non-Banded GBP (n=46) (n=44) BMI 59.4 59.7 Age (years) 40.6 42.6 6months %EWL 43.1 24.7 12months %EWL 64.0 57.8 24 months %EWL 64.2 57.1 38months %EWL 73.4 57.7 Complications %(n) 23.9 (11) 29.5 (13) % of patients achieving 50%EWL 63% 45% His conclusion: It appears the banded gastric bypass produces more weight loss in more patients

17. Non Banded Sleeve Gastrectomy

19. Banded Sleeve Gastrectomy

21. GaBP Ring The GaBP Ring is easily placed in open or laparoscopic operations. It is an auto lock Device <1/10 the size of any of the adjustable bands

22. 1. Increased Weight Loss 2.More weight loss in more patients 3.Enhances weight Loss Maintenance 4. Decreases the incidence of gastric outlet stenosis 5.Decreases the severity of postprandial dumping 6. Minimizes the incidence of reactive hypoglycemia 7.Success Rate 90+%. (90+% of pts with >50PEWL after 5 years of F/U) * 1. Increased Weight Loss 2.More weight loss in more patients 3.Enhances weight Loss Maintenance 4. Decreases the incidence of gastric outlet stenosis 5.Decreases the severity of postprandial dumping 6. Minimizes the incidence of reactive hypoglycemia 7.Success Rate 90+%. (90+% of pts with >50PEWL after 5 years of F/U) * Controls the Pouch Size (GaBP Ring Designed for the banded gastric bypass) Banding the Pouch in GBP : * GBP 70+% BPD 90+% LAGB 50+% SG N.A

23. Cross Section through the Ring Banded Pouch Gastric Bypass Operation For Obesity GaBP RING designed for the Gastric Bypass and The Sleeve Gastrectomy Prefabricated, Standardized and available in 4 sizes GaBP RING designed for the Gastric Bypass and The Sleeve Gastrectomy Prefabricated, Standardized and available in 4 sizes