Banded Versus Non-banded Sleeve Gastrectomy: 5-Year Results of a 3-Year Randomized Controlled Trial

Abstract

Purpose: Banded sleeve gastrectomy (BSG) has been shown to enable better weight loss than non-banded sleeve gastrectomy (SG) in retrospective analyses. These findings were supported by two randomized controlled trials (RCT). However, to date, mid-term prospective data is not available.

Materials and methods: We invited all 94 patients of an RCT comparing banded to non-banded sleeve gastrectomy at 3 years (DRKS00007729) for a 5-year follow-up visit. Eighty-two patients (BSG n = 42; SG n = 40) came for evaluation. Outcome measures were identical with the RCT to allow longitudinal comparison. Data analysis was descriptive and focused on biometric data, development of comorbidities, mid-term complications, quality of life, and type of body contouring surgery (BCS).

Results: The per-protocol analysis revealed a treatment difference of 9% (CI - 1.5 to 19.6) excess weight loss (EWL). Total weight loss (TWL) was 27.4% (CI 23.5-31.3) after SG and 31.6% (CI 27.3-35.5) after BSG. Twenty percent of patients after SG and 11.9% following BSG had been converted to a gastric bypass. Type 2 diabetes went into remission in most patients (SG 66.7% vs. BSG 63.6%). Antihypertensive medication was stopped or reduced in 81.3% after SG and 80% after BSG. Reflux symptoms were similar in both groups (symptoms [Formula: see text] 1/ week: SG 28.2% vs. BSG 26.8%). Frequency of postprandial regurgitation was higher after BSG (SG 23% vs. BSG 59%). Forty percent of patients had undergone BCS at time of follow-up.

Conclusion: Five-year weight loss after BSG was 9% EWL and 4.2% TWL higher compared to SG. The main added morbidity following BSG was postprandial regurgitation.

Keywords: Banded sleeve gastrectomy; Bariatric surgery; Sleeve gastrectomy; Weight loss.

Fig. 1

Flow chart of all patients throughout the randomized controlled trial (RCT) and current follow-up. Results of the RCT (dotted line) were published previously [10]. The chart enumerates all bariatric revisions. In total, 8 revisions were conducted in 6 patients after BSG and 12 revisions in 8 patients following SG

Fig. 2

Spaghetti plot depicting excess weight loss (%EWL; Fig. 2A) and total weight loss (%TWL; Fig. 2B) after sleeve gastrectomy (SG) and banded sleeve gastrectomy (BSG). Displayed data relate to the per-protocol population. Bold lines indicate mean modelled weight loss of the mixed effects analysis. The estimated $\%\mathrm{EWL}\mathrm{difference}$ between SG vs. BSG was 9.0%, the %TWL delta 4.2%. Data to the left of the dotted line depict the RCT results and have been published previously [10]