Banded versus nonbanded laparoscopic sleeve gastrectomy: 5-year outcomes

Laparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric/metabolic operation. However, inadequate long-term weight loss remains a problem in some cases, possibly from gastric-sleeve dilation. Adding a reinforcing ring around the proximal gastric sleeve has been proposed, but relevant data are scant. We performed the largest, longest-term study yet of banded SG (BSG) compared to nonbanded SG.

University hospital.

In 2012, 68 patients at our institution underwent BSG, and 152 underwent SG. Data were prospectively collected into a standardized database from both cohorts during in-person visits at 0, .5, 1, 2, 3, 4, and 5 postoperative years, enabling this retrospective matched cohort study.

The groups were extremely well-matched at baseline for all relevant characteristics. Operative time was longer and blood loss greater with BSG, but these differences were clinically inconsequential. The only major perioperative complications were 1 hemorrhage in each group. Follow-up at 5 years was 81% for BSG and 67% for SG. Weight loss was equivalent between groups at 6 and 12 months. Thereafter, weight loss was substantially greater following BSG compared to SG at 2, 3, 4, and 5 years, with the magnitude of difference increasing at each successive year. At 5 years, total body mass index decrease was 33.0 ± 12.0% for BSG versus 21.7 ± 18.2% for SG (P = .0001). No major late complications occurred in either group. At 5 years, BSG patients reported minimal food intolerances, rare postprandial vomiting, and almost no heartburn.

BSG is safe and produces substantially more weight loss than nonbanded SG at 2 through 5 postoperative years, with minimal side effects.