Five year outcomes from a single-centre study comparing banded laparoscopic sleeve gastrectomy (BLSG) with non-banded laparoscopic sleeve gastrectomy (NLSG) has found that BLSG was more effective in reducing and maintaining weight – with more than 97% of the patients in the BLSG group reporting no weight regain at all, compared to the NLSG group, where only 80% of the patients had no weight regain.
The paper, ‘Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients’, published in Obesity Surgery by researchers from Campus Sint-NiklaasAZ Nikolaas, Sint-Niklaas, Belgium and Bariatric Medicine Institute, Salt Lake City, US, is the first study that has reported the long-term outcomes (>5 years) of BLSG in the obese and superobese patient population.
There have been several published studies demonstrating the long-term weight loss and the prevention of weight regain by placing bands or rings over the gastric tube in LRYGB. However, the authors note, there is a little data on BLSG. As a result, the researchers sought to evaluate the long-term outcomes of BLSG compared with NLSG in terms of weight loss and incidence of complications in obese and the superobese patients out to five years.
All patients followed in a multidisciplinary programme and follow-up visits took place at three, six, 12, 24, 36, 48, and 60 months post-operatively, where BMI and weight were measured, as well as comorbidities such as obstructive sleep apnoea (OSA), T2DM), gastroesophageal reflux disease (GERD), hypertension (HTN), and hyperlipidaemia.
Procedure
Patients in the BLSG group received a silastic ring (MiniMizer Ring, Bariatric Solutions) that was placed 4–5cm from the gastroesophageal junction. The atraumatic needle of the Minimizer ring is introduced behind the sleeve through the lesser omentum in between the vessels of the lesser curvature. It is closed and fixed with two non-resorbable sutures. Ring circumference of 6.5 or 7cm was used for females and 7 or 7.5cm for males. The placement of the ring added less than 5mins to the operation. The authors caution that in order to avoid the damage to the posterior wall of the stomach: “It is essential that the gastric calibration tube is inside at the moment of the ring closure and that there is 5mm space between the ring and the pouch upon closure.”
Outcomes
In total, 147 patients were included in the study with 51 patients in the NLSG group and the remaining 96 patients in the BLSG group. From 147 patients, 112 patients completed follow up at one year, 79 patients two years, 56 patients three years, 36 patients four years and 30 patients completed five years of follow-up.
At five years, the results showed that the BLSG group had less weight regain (2%) compared to NLSG group (19.6%) (p<0.001) and 97.9% of BLSG patients had no increase in BMI points compared to 80.3% of NLSG patients. Moreover, 2% of BLSG patients had an increase of less than 5 BMI points compared to 12% of NLSG patients, 0 patients in BSLG patients had an increase of more than 5 BMI points, compared to 8% of NLSG patients. Superobese BLSG patients had 81.9±1.6% EBMIL and 78.3±1.6% EWL, compared to 67.1 ± 29.4% EBMIL and 61.6 ± 24.6% EWL in the NLSG group - although the difference was not statistically significant.
Complications
Although the complication rate was higher for BLSG patients (14.5%) compared to NLSG patients (9.8%), most of the complications seen within the BLSG group were late and minor. There were three early complications in the BLSG group (post-operative bleeding and an abscess) and no early complications reported within the NLSG group. There were 11 (11.4%) late complications in the BLSG group (vomiting (7.2%) and ring-related problems (4.1%)). The ring-related problems included functional stenosis at the level of the ring that was remedied by ring enlargement to 7.5cm in three patients and one ring removal. There were five (9.8%) late complications in the NLSG group (vomiting (7.8%) and one patient needed revision to bypass for insufficient weight loss and diabetes (1.9%)).
Although the authors acknowledge that the advantage of BLSG comes with a cost of higher late complication rates compared to the NLSG group, most of these complications were minor and acceptable and there was no episodes of ring erosion, slippage or migration with BLSG patients.
“BLSG surgery was found to be safe and effective in maintaining weight loss on the long term compared to the NLSG group with low incidence of band-related problems,” the authors concluded. “Prospective comparative studies with large sample size are needed to further validate our results.”