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Comparison of Outcomes Between Banded and Non-banded Sleeve Gastrectomy: a Systematic Review and Meta-analysis

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Abstract

Background

Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. It accounts for more than 50% of primary bariatric surgeries performed each year. Recent long-term data has shown an alarming trend of weight recidivism. Some authors have proposed the concurrent use of a non-adjustable gastric band to decrease long-term sleeve failure.

Objective

To compare the outcomes (weight loss) and safety (rate of complication and presence of upper GI symptoms) between SG and BSG.

Methods

A systematic search with no language or time restrictions was performed to identify relevant observational studies and randomized controlled trials (RCT) evaluating people with morbid obesity undergoing SG or SGB for weight loss. An inverse-of-the-variance meta-analysis was performed by random effects model. Heterogeneity was assessed using Cochrane X2 and I2 analysis.

Results

A total of 7 observational studies and 3 RCT were included in the final analysis. There were 911 participants pooled from observational studies and 194 from RCT. BSG showed a significant higher excess of weight loss (% EWL). The difference among groups was clinically relevant after the third year where the weighted mean difference (SMD) was 16.8 (CI 95% 12.45, 21.15, p < 0.0001), while at 5 years, a SMD of 25.59 (16.31, 34.87, p < 0.0001) was noticed. No differences related to overall complications were noticed. Upper GI symptoms were up to three times more frequent in the BSG group (OR 3.26. CI 95% 1.96, 5.42, p < 0.0001).

Conclusions

According to the results, BSG is superior to SG in weight loss at 5 years but is associated with a higher incidence of upper GI symptoms. However, these conclusions are based mainly on data obtained from observational studies. Further RCT are needed to evaluate the effect and safety of BSG.

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Author information

Authors and Affiliations

  1. Department of Surgery, Hospital Civil de Morelia Miguel Silva, Morelia, Michoacan, Mexico

    Guillermo Ponce de Leon-Ballesteros

  2. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA

    Gustavo Romero-Velez & Xavier Pereira

  3. Clinical Research Division, National Institute of Perinatology, Mexico City, Mexico

    Raigam Jafet Martinez-Portilla

  4. Fetal Surgery Clinic, ABC Medical Center, Mexico City, Mexico

    Raigam Jafet Martinez-Portilla

  5. Center for Training and Clinical Research, Instituto Mexicano del Seguro Social, Mexico City, Mexico

    Ivonne Roy-Garcia

  6. Mohak Bariatrics and Robotics Surgery Center, Indore, India

    Mathias A. L. Fobi

  7. Clinic for Nutrition and Obesity, ABC Medical Center, 116, Sur 136, Las Américas, Álvaro Obregón, 01120, Mexico City, Mexico

    Miguel F. Herrera

  8. Department of Surgery, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubiran, Mexico City, Mexico

    Miguel F. Herrera

Authors
  1. Guillermo Ponce de Leon-Ballesteros
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  2. Gustavo Romero-Velez
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  3. Raigam Jafet Martinez-Portilla
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  4. Xavier Pereira
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  5. Ivonne Roy-Garcia
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  6. Mathias A. L. Fobi
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  7. Miguel F. Herrera
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Corresponding author

Correspondence to Miguel F. Herrera.

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Conclusions

According to the results, BSG is a safe and effective procedure with acceptable rates of perioperative and band-related complications. Mid- (3 years) and long-term (5 years) weight loss may be superior in BSG compared to SG but may come at the expense of a higher incidence of upper GI symptoms such as food intolerance, vomiting, and regurgitation. A 6.5-cm band is associated to a higher incidence of upper GI symptoms, in comparison to a band greater than 7 cm.

However, these findings are mainly based on data obtained from observational studies. Further RCT are needed to validate these results, as well as studies with longer follow-up to assess safety and efficacy of BSG at long term.

This article does not contain any studies with human participants or animals performed by any of the authors.

Consent Statements

Non-applicable.

Conflict of Interest

Guillermo Ponce de Leon-Ballesteros has nothing to disclose. Gustavo Romero-Velez has nothing to disclose. Raigam Jafet Martinez-Portilla has nothing to disclose. Xavier Pereira has nothing to disclose. Ivonne Roy-Garcia has nothing to disclose. Mathias AL Fobi has ownership of share in Bariatec Corporation. Miguel F Herrera has nothing to disclose.

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Key Points

- Banded sleeve gastrectomy (BSG) has been proposed as an alternative to SG as it can limit gastric pouch dilation.

- Seven case-control studies and three randomized clinical trials have compared the outcomes between SG and BSG.

- BSG has significant higher %EWL compared to SG.

- BSG showed a higher frequency of upper gastrointestinal symptoms on follow-up on observational studies. According to the RCT, there was no significant difference among groups.

Article Category: Systematic review. No previous presentation in a meeting or to a society.

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Ponce de Leon-Ballesteros, G., Romero-Velez, G., Martinez-Portilla, R.J. et al. Comparison of Outcomes Between Banded and Non-banded Sleeve Gastrectomy: a Systematic Review and Meta-analysis. OBES SURG 32, 1–12 (2022). https://doi.org/10.1007/s11695-022-06043-7

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  • DOI: https://doi.org/10.1007/s11695-022-06043-7

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