Renaming banded procedures to ‘Ring-augmented procedures’ would provide clarity for researchers and patients
- owenhaskins
- May 12
- 5 min read
In March 2024, an international group of bariatric and metabolic experts wrote a letter, published in Obesity Surgery(1), calling for a renaming of bariatric procedures so a clear distinction could be made between ‘band’ and ‘ring’ procedures. We spoke with the co-author of the letter, Professor Mohamed Hany from Alexandria University and Consultant of Bariatric Surgery at Madina Women’s Hospital, Alexandria, Egypt, who explained why he believes the procedures utilising a ring should be renamed ‘Ring-augmented procedures’.
“The distinction between ‘band’ and ‘ring’ procedures is necessary because they represent fundamentally different mechanisms that affect patient outcomes in distinct ways,” Professor Hany explained. “As we highlighted in our letter, the term ‘band’ is currently used to describe two completely different devices: the laparoscopic adjustable gastric band (LAGB), which is an inflatable device placed tightly around the stomach, and a non-adjustable, non-inflatable ring, which should be positioned loosely around the pouch. These mechanisms operate differently, with different clinical implications for patients.”
Indeed, the data shows that these procedures have distinctly different outcomes. LAGBs have been declining in popularity worldwide (from 42.3% in 2008(2) to just 0.8% in 2022(3), partly due to high complication rates of 42.7% and reoperation rates of 36.5% at long-term follow-up(4). In contrast, ring augmentation has demonstrated improved weight loss outcomes when added to procedures like sleeve gastrectomy and Roux-en-Y gastric bypass, with revision rates attributable to the Ring of only about 7.1%(5).
Epidemiological perspective
Moreover, from an epidemiological perspective, using the same terminology for different interventions creates significant problems for research, clinical decision-making, and meta-analyses. Therefore, he believes the metabolic and bariatric surgery (MBS) community need precise terminology to accurately assess outcomes and provide evidence-based recommendations.
“Our literature search revealed significant terminology confusion. A simple Google search for ‘band placement in MBS’ yielded results predominantly describing the classic LAGB, with no mentions of ‘ring’ procedures. The results only changed when we explicitly searched for the term ‘ring.’ Similarly, a PubMed search for ‘banded MBS procedures’ returned a mix of both (adjustable) LAGB and (non-adjustable) banded RYGB, LSG or other procedures, making it extremely challenging to distinguish between the two types of interventions,” he added. “This inconsistent terminology creates barriers for systematic reviews and meta-analyses, which are foundational to evidence-based medicine. I find this particularly problematic because it hampers our ability to synthesise evidence accurately, potentially leading to incorrect conclusions about efficacy and safety profiles.”
According to Professor Hany, the lack of clarity has significant consequences for both patients and healthcare providers. For patients, unclear terminology can be misleading when they search for information about adding a ‘band’ to their LSG, RYGB or other procedures. They may encounter information about LAGBs – which have high complication rates, when they are actually interested in ring augmentation, which has a different risk profile and potential benefits.
For healthcare providers and researchers, this confusion impedes evidence synthesis and clinical decision-making. When conducting systematic reviews or meta-analyses, it becomes extremely difficult to ensure we’re comparing similar interventions. This undermines the ability of researchers to develop evidence-based guidelines and provide patients with accurate information about expected outcomes.
“We have proposed using the term ‘Ring-augmented’ for all nonrestrictive, noninflatable devices and reserving ‘band’ for restrictive and inflatable devices. This distinction is more than semantic – it reflects the fundamental mechanical and functional differences between these approaches. Precise terminology allows for more accurate communication, better research, and ultimately improved patient care through evidence-based practice.”
Consequently, from a research methodology perspective, this terminological imprecision introduces heterogeneity into analyses that does not reflect actual clinical differences, but rather stems from inconsistent nomenclature.
Ring-augmented procedures
“We have proposed using the term ‘Ring-augmented’ for all non-restrictive, non-inflatable devices and reserving ‘band’ for restrictive and inflatable devices. This distinction is more than semantic – it reflects the fundamental mechanical and functional differences between these approaches,” he reasoned. “Precise terminology allows for more accurate communication, better research, and ultimately improved patient care through evidence-based practice.”
The Ring is used to augment other procedures like LSG or RYGB, providing additional long-term weight loss benefits without the same restrictive mechanism as a band. Systematic reviews showed that ring augmentation in LSG resulted in improved weight loss of 6.4% and 9.9% total weight loss at three- and five-year post-operation(6), while in RYGB, it demonstrated a 5.6% higher excess weight loss compared to procedures performed without a ring(7).
Professor Hany said that the response from colleagues has been generally positive, with many acknowledging the need for more precise terminology in MBS. Many surgeons have experienced the confusion first hand when discussing these procedures with patients or when reviewing literature.
“For next steps, we believe journal guidelines need to incorporate this terminological distinction. Editorial boards should update their submission requirements to ensure authors clearly specify whether they’re discussing bands or rings rather than using ambiguous terms like ‘banded procedures.’ Reviewers should also be instructed to flag imprecise terminology during the peer review process. Several journals in the MBS field have already expressed interest in adopting these changes,” he reported. “Additionally, we’re working to update indexing keywords in medical databases like PubMed and Embase. By establishing ‘Ring-augmented’ as a distinct ‘Medical Subject Headings’ term or keyword separate from ‘gastric banding,’ future studies will be properly categorised, making literature searches more accurate and comprehensive. This will gradually create a more organized knowledge base where researchers and clinicians can find relevant information without confusion.”
Furthermore, he said that national societies and organisations like the International Federation for the Surgery of Obesity and Metabolic Disorders also have a critical role to play by adopting standardized terminology in their guidelines, publications, and registries. The IFSO Global Registry, which collects data worldwide, would particularly benefit from implementing this distinction.
“Ultimately, consistent usage over time will solidify these terms in the field’s vocabulary, leading to better communication, more precise research and improved patient care,” he concluded.
The co-authors of the letter to Obesity Surgery were Dr Bart Torensma (Leiden University Medical Center, Leiden and WeightWorks Clinics, Amersfoort, The Netherlands and the Medical Research Institute, Alexandria University, Alexandria, Egypt), Dr Frits Berends (WeightWorks Clinics, Amersfoort, The Netherlands), Dr Edo Aarts (WeightWorks Clinics, Amersfoort, The Netherlands), Professor Jodok Fink (Emmendingen District Hospital, Emmendingen, Germany) and Dr Evert-Jan Boerma (Zuyderland Medical Center, Heerlen, The Netherlands).
References
Torensma, B., Hany, M., Berends, F. et al. Clarifying Terminology in Bariatric Metabolic Surgery: The Need for Distinction Between “Band” and “Ring”. OBES SURG 34, 1958–1959 (2024). https://doi. org/10.1007/s11695-024-07168-7
IFSO Worldwide Survey 2020-2021: current trends for bariatric and metabolic procedures. Angrisani L., Santonicola A., Iovino P. Obes Surg. 2024;34:1075-1085. doi: 10.1007/s11695-024- 07118-3.
Bariatric surgery worldwide 2013. Angrisani L., Santonicola A., Iovino P. Obes Surg. 2015;25:1822- 1832. doi: 10.1007/s11695-015-1657-z.
Shen X, Zhang X, Bi J, Yin K. Long-term complications requiring reoperations after laparoscopic adjustable gastric banding: a systematic review. Surg Obes Relat Dis. 2015 Jul-Aug;11(4):956-64. doi: 10.1016/j.soard.2014.11.011. Epub 2014 Nov 21. PMID: 25638595.
Gupta M, Singla V, Kumar A, Chekuri R, Kaustubh YS, Aggarwal S. Banded Sleeve Gastrectomy vs Non-banded Sleeve Gastrectomy: a Systematic review and Meta-analysis. Obes Surg. 2022 Aug;32(8):2744-2752. doi: 10.1007/s11695-022-06129-2. Epub 2022 Jun 2. PMID: 35653009.
Gupta M, Singla V, Kumar A, Chekuri R, Kaustubh YS, Aggarwal S. Banded Sleeve Gastrectomy vs Non-banded Sleeve Gastrectomy: a Systematic review and Meta-analysis. Obes Surg. 2022 Aug;32(8):2744-2752. doi: 10.1007/s11695-022-06129-2. Epub 2022 Jun 2. PMID: 35653009.
Shoar S, Khorgami Z, Brethauer SA, et al. Banded versus nonbanded Roux-en-Y gastric bypass: a systematic review and metaanalysis of randomized controlled trials. Surg Obes Relat Dis. 2019;15:688–95
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