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Banding the sleeve

Banding sleeve gastrectomy “just makes sense”

Dr MAL Fobi, a world-renowned bariatric surgeon and past president of the International Federation for the Society of Obesity and Metabolic Surgery (IFSO), discusses the viability of banding the sleeve gastrectomy.

Dr Fobi believes that there is no reason not to band sleeve gastrectomies.

In a presentation at a surgeons’ workshop in Sint Nicklaas, Belgium, Fobi stated, “It just makes sense to band the sleeve gastrectomy operation, just as the gastroplasty operations were banded and as the gastric bypass operation is banded to enhance the restrictive mechanism of the operation”.

The sleeve gastrectomy is being used more frequently as more and more surgeons are switching from gastric banding.

Sleeve gastrectomy is currently understood to induce three mechanisms are:

  1. The ghrelin effect (resecting the parietal mass that produce ghrelin resulting in anorexia);
  2. The restrictive effect (creation of a small tubular stomach pouch that decreases the caloric intake) and;
  3. The rapid transit effect (rapid transit of food from the small sleeve gastrectomy stomach into the small bowel thus releasing incretins from the small bowel that inhibit caloric intake).

It has been reported that in the first year after the sleeve gastrectomy the weight loss is more rapid than seen with the gastric bypass and the total weight loss approaches that reported after the gastric bypass operation (Sleeve Gastrectomy Summit, OOBSJ, 2012).

“We do not have to reinvent the wheel," Fobi said. “Thirty to fifty percent of patients with a sleeve gastrectomy will have progressive weight regain because of the dilation of the sleeve pouch. This minimises the restrictive component of the operation requiring revision surgery, which may be either re-sleeving or conversion of the sleeve gastrectomy to either a gastric bypass or BPD with a switch.”

In an effort to address this loss in the restrictive mechanism of the sleeve gastrectomy, as more and more surgeons use the sleeve gastrectomy as a stand alone operation, there has been the trend towards a very narrow sleeve resulting in a significant leak rate (intractable leaks), strictures and reflux. Banding the sleeve gastrectomy enhances the restrictive mechanism just like banding the gastroplasty operations and gastric bypass operation.

Surgeons banding the sleeve gastrectomy with a GaBP ring have documented control of the reservoir capacity of the sleeve and prolongation of the weight loss maintenance.

Bariatec Corporation, the maker of the GaBP ring for banding the gastric bypass, the sleeve gastrectomy and other gastroplasty operations, is carrying out a multi-centre international prospective clinical trial to substantiate the benefit of banding the sleeve.

“Until prospective clinical trials with long term results are performed and reported,” Fobi emphasised. “It just makes sense to band the sleeve gastrectomy operation.”