BANDED SLEEVE Gastrectomy

“Banded sleeve gastrectomy is a feasible procedure with a short learning curve, with no impact on postoperative complications. Banded sleeve gastrectomy seems to be significantly more effective than the standard LSG in terms of weight loss in the midterm follow-up.

 

These encouraging results should open the way to standardize LBSG as a defined procedure in the bariatric community, maybe lowering the need of revisional surgery.”

 

Gentileschi

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.

As early as 2009 the first reporting came out on Banded Sleeve Gastrectomy addressing the flaws of Sleeve Gastrectomy, long term weight regain and reflux. In recent years Randomized Controlled Trials have been published displaying outstanding long-term weight loss results for Banded Sleeve Gastrectomy!

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. ”

Dillemans (1)

 

Weight Regain
after Sleeve

Gastrectomy

Whether the etiology 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, slow down the passage of food and increase gastric restriction to promote weight loss in the long term, one can perform a combined procedure of placing a ring with a sleeve gastrectomy.

 

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 a gastric ring around the upper sleeve will further limit the volume of food intake, slow down the passage of food and prevent dilatation of the gastric sleeve distal to the ring in the long term.

Therefore the ring will help in maintaining the weight, especially when restriction starts to fail and weight regain occurs due to, amongst others, gastric dilatation.

It should however be possible to fix the ring directly to the gastric sleeve to prevent it from slipping. The MiniMizer Gastric Ring fulfils this requirement.

Primary Banded Sleeve Gastrectomy
Doing it right the first time!

Since 2009 several papers and case reports have been published. The most recent publications include 2 Randomised Controlled Trials by Fink (8) and Gentileschi (9). These studies both show superior weight loss outcomes for Banded Sleeve Gastrectomy with up to 5 years follow up.

These data can be added to the already exisiting case reports and smaller series by Dillemans (1)Alexander (2)Karcz (3) and Schauer (4) which 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 Gentileschi (9) in a randomized prospective setting.

Karcz pointed out that the level of placement of the gastric ring should not be lower than 4 cm 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 result in publications soon.

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

Complications of Banded Sleeve Gastrectomy

“Also after the extended follow-up, we did not record any complication band-related and the pre-existing diseases kept improving over time.”

Gentileschi

“No one in either group experienced gastric stenosis, fistula, band erosion, band migration, band slippage, leak, reoperation for complications, or death during the 5-year follow-up.”

Fink

Reflux after Banded Sleeve Gastrectomy

Fink in their randomized controlled trial published in the Annals of Surgery mentions the following: “Previous examinations showed reduced frequency of reflux symptoms after BSG. This trial supports these results at final follow-up. Possibly, the ring acts as a reflux barrier as suggested by Mason in vertical banded gastroplasty”.

Bhandari also stated on reflux in his study:  “A loose-fitting band accomplishes these benefits while minimizing risk of reflux-related side effects and band erosion.” The potential of the MiniMIZER Gastric Ring in the prevention of Reflux needs to be further investigated.

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
  7.  Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients (746 kb)
    Luc Lemmens, Jelmer Van Den Bossche, Hinali Zaveri, Amit Surve
  1. Banded Versus Nonbanded Sleeve GastrectomyA Randomized Controlled Trial With 3 Years of Follow-upJodok M. Fink, MD,Y Andrea Hetzenecker, MD, Gabriel Seifert, MD, Mira Runkel, MDClaudia Laessle, MD, Stefan Fichtner-Feigl, MD, and Goran Marjanovic, MD
  2. Banded Sleeve Gastrectomy Improves Weight Loss Compared to Nonbanded Sleeve: Midterm Results from a Prospective Randomized StudyPaolo Gentileschi,1 Emanuela Bianciardi ,2 Leandro Siragusa,3 Valeria Tognoni ,Domenico Benavoli ,3 and Stefano D’Ugo 4
  3. Banded versus nonbanded laparoscopic sleeve gastrectomy: 5-year outcomes

Mohit Bhandari, M.D.a, Winni Mathur, M.B.A.a, Susmit Kosta, Ph.D.a,

Arun K. Mishra, M.S.a, David E. Cummings, M.D.b,*

  1. Banded versus nonbanded sleeve gastrectomy: 5-year results of a matched-pair analysis

Jodok M. Fink, M.D., A.P.*, Anais von Pigenot, Gabriel Seifert, M.D., Claudia Laessle, M.D.,

Stefan Fichtner-Feigl, M.D., Goran Marjanovic, M.D., A.P.

Products

MiniMizer Gastric Ring, Adjustable Gastric Band, Calibration Tube, Pinky Trigger, Cobra Liver Retractor, P. Galore Band Introducer. more

Adjustable Gastric Banding

Gastric banding with the MiniMizer gastric band prevents slipping and offers two sizes in one device. more

Banded Gastric Bypass

Banded Gastric Bypass publications and video footage by various surgeons are available on this page. Continuous updates on new studies are available. more