Banded Versus Nonbanded Sleeve Gastrectomy

A Randomized Controlled Trial With 3 Years of Follow-up

Jodok M. Fink, MD; Andrea Hetzenecker, MD; Gabriel Seifert, MD; Mira Runkel, MD; Claudia Laessle, MD; Stefan Fichtner-Feigl, MD; Goran Marjanovic, MD

Disclosures

Annals of Surgery. 2020;272(5):690-695.

Conclusion

Among patients with obesity, BSG led to better EWL compared to non-banded SG 3 years after surgery.

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A.H., M.R., C.L., S. F.F. have received travel sponsoring by Bariatric Solutions, Weil am Rhein, Germany

Acknowledgments
The authors thank Olivia Sick for outcome recording and management as well as Jeramiah Perez for statistical support.

Table 1. Development of Type 2 Diabetes, Antihypertensive Medication Use, and Reflux Esophagitis At 3 Years in Relation to Baseline, Incidence of Vitamin Deficiencies Following Banded and Nonbanded Sleeve Gastrectomy
Category	Banded Sleeve Gastrectomy (n = 47)	Sleeve Gastrectomy (n = 47)	Chi Square, P
Type 2 diabetes
Comorbidity present at baseline	11	6	0.18
Remission, no. (% of base.)	10 (90.9)	4 (66.7)	0.21
Improvement, no. (% of base.)	1 (9.1)	2 (33.3)
Unchanged, no. (% of base.)	0	0
Worsened, no. (% of base.)	0	0
HbA1c at baseline, mean (95% CI)	6.8 (5.9–7.7)	7.3 (6.1–8.5)	1.0*
HbA1c 3 y, mean (95% CI)	5.9 (5.0–6.8)	5.9 (4.7–7.0)	1.0*
Antihypertensive medication use
Medication use at baseline	25	16	0.06
Stopped, no. (% of base.)	16 (64.0)	7 (43.8)	0.32
Lowered, no. (% of base.)	7 (28.0)	6 (37.5)
Unchanged, no. (% of base.)	1 (4.0)	2 (12.5)
Increased, no (% of base.)	0	1 (6.25)
Lost to follow-up, no.	1	0
Reflux esophagitis
Comorbidity present at baseline	11 (23.4)	6 (12.8)	0.18
Remission, no. (% of base.)	4 (36.4)	4 (66.7)	0.15
Improvement, no. (% of base.)	2 (18.2)	0
Unchanged, no. (% of base.)	3 (27.3)	0
Worsened, no. (% of base.)	0	1 (16.7)
Lost to follow-up, no.	2	1
De novo esophagitis, no. (%^†)	5 (20.8^†)	10 (30.3^†)	0.42
Vitamin deficiency (ref. interval)
Vitamin D3 (50–174.7 nmol/L)
baseline, no. (% of n)	8 (20.0; n = 40)	7 (18.4; n = 38)	0.86
3 years, no. (% of n)	11 (32.4; n = 34)	14 (37.8; n = 37)	0.63
Vitamin B1 (89–225.3 nmol/L)
baseline, no. (% of n)	0 (n = 40)	0 (n = 38)
3 years, no. (% of n)	0 (n = 31)	0 (n = 34)
Vitamin B12 (145.3–568.8 pmol/L)
Baseline, no. (% of n)	1 (2.5; n = 40)	0 (n = 38)	0.34
3 y, no. (% of n)	1 (2.9; n = 34)	1 (2.7; n = 37)	0.95
Folic acid (10.4–42.4 nmol/L)
Baseline, no. (% of n)	1 (2.5; n = 40)	4 (10.5; n = 38)	0.15
3 y, No. (% of n)	5 (15.6; n = 32)	11 (30.6; n = 36)	0.15

*Bonferroni-Holm corrected P value for linear mixed effects model (95% confidence interval).
^†Reference to patients with no esophagitis preoperatively that underwent gastroscopy postoperatively (banded sleeve gastrectomy n = 24; sleeve gastrectomy n = 33).

Table 2. Baseline Patient Characteristics
Characteristic	Banded Sleeve Gastrectomy (n = 47)	Sleeve Gastrectomy (n = 47)
Age, y, mean (95% CI)	43.3 (40.6–46)	40.9 (38.2–43.5)
Female, No. (%)	35 (74.5)	31 (66)
Weight, mean (95% CI), kg	147 (139.2–154.8)	147.5 (139.1–155.9)
BMI, mean (CI), kg/m²	51 (49.1–53)	50.7 (48.8–52.6)
Type 2 diabetes, no. (%)	11 (23.4%)	6 (12.8%)
Hypertension, no. (%)	26 (53.3)	20 (42.6%)
Gastroesophageal reflux complaint ≥1/wk, No. (%)	7 (14.9)	7 (14.9)
Hiatal hernia	9 (19.1)	6 (12.8)
Refluxesophagitis, no (%)	11 (23.4)	6 (12.8)

Table 3. Complications Following Banded and Nonbanded Sleeve Gastrectomy
Complication and Category	Banded Sleeve Gastrectomy (n = 45)	Sleeve Gastrectomy (n = 46)	Chi Square, P
Minor early (≤30 days), no. (%)
Bleeding	0	1/47 (2.1)
Total	0	1 (2.1)	0.31
Minor late (>30 days), no. (%)
Regurgitation ≥1/wk	6 (13.3)	2 (4.3)
Gastroesophageal reflux RSI >13	3 (6.5)	4 (8.7)
Sleeve stenosis	0	1 (2.2)
Symptomatic cholelithiasis	2 (4.4)	2 (4.3)
Total	10 (22.2)	9 (19.6)	0.76
Major late (>30 days), No. (%)
Ring slippage	1 (2.2)	0
Gastroesophageal reflux with conversion to RYGB	2 (4.4)	1 (2.2)
Incisional hernia	0	1 (2.2)
Total	3 (6.6)	2 (4.3)	0.63

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