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.

 

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. Bhandari produced the following five years results comparing banded gastric bypass to non-banded gastric bypass.

 

Fig. 1. Changes in weight and glycemia over 5 years. Shown are 5-year time courses for percent change in (A) body mass index (BMI), (B) absolute BMI values, (C) percent excess weight loss (%EWL), (D) hemoglobin A1C (HbA1C), and (E) fasting plasma glucose among patients who underwent either banded sleeve gastrectomy (BSG, red circles, solid lines) or nonbanded sleeve gastrectomy (SG, blue triangles, dashed lines). Data are expressed as means 6 SEM. Asterisks indicate statistically significant differences between groups at individual timepoints. Percent excess weight loss was calculated using an ideal weight as that equivalent to a BMI of 25 kg/m2. N 5 number of patients with available data at each timepoint.

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

Various authors have reported limited or even less complications of any relevance between banded gastric bypass and it’s non-banded counterpart.

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

And Fink mentioned that “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.”

Banded Sleeve Gastrectomy is related to higher level of regurgitation and dysphagia, but this is also partially due to the positively restricting effect of the device. Without any regurgitation the MiniMIZER RING would not funtion properly.

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
                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
                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
                Valeria Tognoni, Domenico Benavoli, Emanuela Bianciardi, Federico Perrone, Simona Ippoliti, Achille Gaspari and Paolo Gentileschi
              7.  Banded Sleeve Gastrectomy: Better Long-Term Results? A Long-Term Cohort Study Until 5 Years Follow-Up in Obese and Superobese Patients
                Luc Lemmens, Jelmer Van Den Bossche, Hinali Zaveri, Amit Surve
                1. Banded Versus Nonbanded Sleeve GastrectomyA Randomized Controlled Trial With 3 Years of Follow-up
                  Jodok 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 Study
                  Paolo 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

                  4. 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

                        2. 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.

Video Library

  1.  Prof. Dr. Karcz performs banded sleeve gastrectomy with MiniMIZER RING (68,2 MB)
  2.  Upward peristaltic wave of antrum pump courtesy Prof. Dr. Karcz (1,63 MB)

Interviews

Products

MiniMIZER Gastric RING, MiniMIZER Adjustable Gastric BAND, CalibrationTUBE, PinkyTRIGGER, GreenMAMBA 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

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