gms | German Medical Science

Background: Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed weight loss operation in Germany. Although this procedure can achieve excellent weight loss, weight regain due to sleeve dilatation is a relevant obstacle of this procedure. In our centre, banded sleeve gastrectomy (BLSG) is performed as an option to counteract sleeve dilatation and ameliorate weight loss after sleeve gastrectomy.

Materials and methods: In a retrospective matched pair analysis, we analysed 42 patients who underwent BLSG using a MiniMizer^® ring from January 2012 to October 2014 regarding weight loss and postoperative comorbidity. Median follow-up was 3 years. The ring was placed 5-6 cm below the gastro-esophageal junction. 42 patients who had previously undergone a conventional LSG were selected as matched pairs.

Results: Mean preoperative BMI was 54.93 ± 7.42 kg/m² for BLSG and 53.46 ± 6.69 kg/m² for LSG (Mann-Whitney P=0.540). Excess weight loss (%EWL) in the BLSG group amounted to 64.12 1 year after surgery, to 65.62 and 66.66 2 and 3 years post operation. In the conventional LSG group, %EWL was 57.29 and 60.88 1 and 2 years after surgery. At 3 years, the conventional LSG group showed an impaired overall weight loss with 55.95. Overall %EWL after 3 years was significantly larger in the BLSG group (two-way ANOVA and Mann-Whitney P<0.05). Ring placement had no relevant impact on new-onset reflux (Fisher´s exact test P=1.0), but a tendency towards reflux improvement when reflux pre-existed (Odds ratio 1.96). The major side effect of ring implantation was regurgitation with over 44% of patients presenting with regurgitation > 1 per week (Fisher´s exact test P=0.0019, Odds ratio 18.07). Overall, 3 rings had to be removed for this reason. There was no procedure-related mortality in either group.

Conclusion: Additional ring implantation shows improved weight loss 3 years after sleeve gastrectomy. When there was no relevant impact on postoperative reflux, ring implantation significantly increases postoperative regurgitation. With the aim to further evaluate the role of primary ring implantation in sleeve gastrectomy, a prospective randomized trial is necessary.