Banded Sleeve

“ … silicone-banded LSG is feasible, with minimal morbidity and significant EWL at short-term follow-up. ”

Schauer

Banded Sleeve

Banded Sleeve

History of the Banded Sleeve Gastrectomy

“ Sleeve gastrectomy was first described as a modification to the bilio-pancreatic diversion and combined with a duodenal switch in 1998. It was first performed laparoscopically in July 1999 and reported the following year.

Laparoscopic sleeve gastrectomy, as a primary operation in the management of morbid obesity, was first reported in 2003.

Since then, multiple recent reports have documented sleeve gastrectomy as single therapy in the treatment of morbid obesity. With increasing experience, a number of complications have been reported with SG including dilatation of the remaining stomach. Also, doubts still persist regarding long-term weight loss. ”

Weight Regain after Sleeve Gastrectomy

Whether the aetiology of failed excess weight loss is the result of an inadequate sleeve or attributable to dilatation of the sleeve is not clear.

In an effort to prevent gastric dilatation and increase gastric restriction to promote weight loss in the long term, one can perform a combined procedure of placing a gastric band or ring with a sleeve gastrectomy.

gastric ring around gastric pouch
Fig. 2: gastric ring around gastric pouch (courtesy Prof. Dr. Karcz)

Video 1: Prof. Dr. Karcz performs banded sleeve gastrectomy with MiniMizer Ring

The placement of an adjustable band or gastric ring around the upper sleeve will further limit the volume of food intake and prevent dilatation of the gastric sleeve distal to the band in the long term. With a band or ring component, there is a sequential action mechanism: Sleeve gastrectomy is mainly active at the beginning, while gastric restriction from a band or ring will result in further weight loss following this period. Also, the band/ring will help in maintaining the weight, especially when restriction starts to fail and weight regain occurs due to gastric dilatation. The procedure thus combines the potential benefits of SG and gastric banding.

It should however be possible to fix the band or ring directly to the gastric sleeve to prevent it from slipping. Both the MiniMizer Extra gastric band as the MiniMizer Gastric Ring fulfil this requirement.

Publications on Banded Sleeve Gastrectomy

So far various case reports and small series by Dillemans (1), Alexander (2), Karcz (3) and Schauer (4) have demonstrated the safety of the procedure and its short term effectiveness. Dr. Chandraratna (5) et al presented his first year results with 756 patients at the IFSO 2015 in Vienna, confirming that there were no ring related complications. Similar results were reported by Gentlischi (6) in a randomized prospective setting.

Karcz pointed out that the level of placement of the gastric ring should not be lower than 4cm below the gastro esophageal junction, to avoid pressure build up from the distal antrum pump. (see video 2)

Several trials are in process and will be published soon.

Video 2: Upward peristaltic wave of antrum pump (courtesy Prof. Dr. Karcz)

Literature

  1. Laparoscopic Adjustable Banded Sleeve Gastrectomy as a Primary Procedure for the Super-Super Obese (Body Mass Index>60 kg/m2)
    Sanjay Agrawal & Els Van Dessel & Faki Akin & Sebastiaan Van Cauwenberge & Bruno Dillemans
  2. Banded Sleeve Gastrectomy - Initial Experience
    Wesley Alexander & Lisa R. Martin Hawver & Hope R. Goodman
  3. To Band or Not to Band—Early Results of Banded Sleeve Gastrectomy (271 kb)
    W. Konrad Karcz & Iwona Karcz-Socha & Goran Marjanovic & Simon Kuesters & Matthias Goos & Ulrich T. Hopt & Tomasz Szewczyk & Tobias Baumann & Jodok Matthias Grueneberger
  4. Primary Silicone-Banded Laparoscopic Sleeve Gastrectomy: A Pilot Study
    Christopher R. Daigle, MD, Ricard Corcelles, MD, PhD, and Philip R. Schauer, MD
  5. The MiniMizer Ring is a safe edition to laparoscopic sleeve gastrectomy (481 kb)
    Harsha Chandraratna, Stephen Watson, Chris Couch, William V Braun MD, Tim Wright & Jo Climo
  6. Laparoscopic Sleeve Gastrectomy versus Laparoscopic Banded Sleeve Gastrectomy: First Prospective Pilot Randomized Study (1.957 kb)
    Valeria Tognoni, Domenico Benavoli, Emanuela Bianciardi, Federico Perrone, Simona Ippoliti, Achille Gaspari and Paolo Gentileschi Gastroenterology Research and Practice Volume 2016, Article ID 6419603, 5 pages