Comparison of Sleeve Volume Between Banded and Non-banded Sleeve Gastrectomy: Midterm Effect on Weight and Food Tolerance-a Retrospective Study

Comparative Analysis of Laparoscopic Sleeve Gastrectomy with and Without Prior Endoscopic Intragastric Balloon Insertion: Examining Stomach Volumetry, Histopathologic Changes, Hormonal Levels, and Postoperative Outcomes

BACKGROUND

The effects of prior intragastric balloon (IGB) placement on stomach volumetry, surgical technique, and outcomes in laparoscopic sleeve gastrectomy (LSG) patients are unclear.

METHODS

This prospective cohort study analyzed stomach histology, gastric volume, and hormonal markers in 90 LSG patients (45 with prior IGB, 45 without). We assessed stomach wall thickness, fibrosis, smooth muscle density, and ghrelin-positive cells, along with intraoperative parameters like stapler cartridge use and operative time. Postoperative outcomes, including weight loss and food tolerance (FT), were compared between groups at 6 months and 1 year.

RESULTS

In the 6th month and 1st year, the two groups had no differences in weight, BMI, and %TWL before and after the Inverse Propensity Score-Weighted adjustment. The IGB group had significantly increased muscular thickness, smooth muscle cell count, and fibrosis (p < 0.001) but similar mucosa thickness and inflammation. Preoperative stomach and resected specimen volumes were higher in the IGB group (p < 0.001). Both groups showed slight increases by 1 year, with no significant FT differences. Furthermore, no significant difference in postoperative complications was noted. Hormonal changes were observed, including lower leptin levels in the IGB group throughout.

CONCLUSION

While prior intragastric balloon (IGB) placement induces significant volumetry changes and hormone levels, it does not affect surgical outcomes-including postoperative complications, weight loss, resolution of associated medical problems, the duration of IGB placement, or the interval between IGB removal and LSG surgery-compared to those without IGB.

Comparison of food tolerance among bariatric surgery procedures: a systematic review

Bariatric surgeries are related to reduced food tolerance (FT), which may impact on nutritional status and weight loss treatment. The present study was conducted to compare the effects of gastric banding (GB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) on FT. A literature search was performed using Scopus, PubMed, Web of Science, and Google Scholar to find relevant studies published up to August 2023. The primary outcome was the postoperative overall FT score assessed by the Quality of Alimentation questionnaire. Overall, 27 studies containing 4366 adults were included in the review: 15 cohort studies, 5 interventional studies, and 7 cross-sectional studies. The quality of articles ranged between low and high. Thirteen studies evaluated the effect of SG on FT; however, 4 studies reported FT following RYGB. The postsurgery FT of GB patients was examined in 1 study. The mixture of bariatric techniques was evaluated in 9 papers. Selected studies assessed FT from 1 month to 5 years following obesity surgery. Taken together, GB patients showed the lowest level of FT. Although SG and RYGB patients had no difference in FT, RYGB ones had better tolerance to protein-rich foods such as red meat, white meat, and fish. Both SG and RYGB individuals tolerated vegetables and fish more than other food groups and could least tolerate red meat and grains. After the first postoperative year, a good level of FT was found among SG and RYGB patients.

Banded Versus Non-banded Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

Standard bariatric surgeries include biliopancreatic diversion (BPD), sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB). Laparoscopic sleeve gastrectomy (LSG) is currently favored due to safety, efficacy, and shorter operation time. However, previous literature shows 75.6% weight regain post LSG. Introducing Laparoscopic band sleeve gastrectomy (LBSG) to maintain pouch size is proposed to improve outcomes and reduce weight regain. This study aims to compare the safety and efficacy of LSG vs. LBSG in obese patients. A comprehensive search strategy was executed to identify pertinent literature comparing LBSG and LSG in obese patients. Eligible studies underwent independent screening, and pertinent data were systematically extracted. The analysis employed pooled risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous variables, each accompanied by their respective 95% confidence intervals (CI). Our systematic review and meta-analysis included 15 studies encompassing 3929 patients. Regarding body mass index (BMI), at six, 12, and 24 months, no substantial differences were found between LBSG and LSG groups (p < 0.05). Still, at 36 months, LBSG exhibited significantly lower BMI than LSG (MD = -2.07 [-3.84, -0.29], p = 0.02). Excess Weight Loss (EWL) favored LBSG at 12, 24, and 36 months with MD of 3.30 [0.42, 6.18], 4.13 [1.44, 6.81], and 18.43 [9.44, 27.42], p = 0.02, 0.003, < 0.00001, respectively). Operative time did not significantly differ between the procedures (MD = 2.95, 95%CI [-0.06, 5.95], p = 0.05). Resolution of comorbidities, overall complications, post-operative bleeding, reflux, and early complications did not significantly differ between LBSG and LSG. However, LBSG showed higher post-operative regurgitation than LSG (RR = 2.38, 95%CI [1.25, 4.54], p = 0.008). LBSG showed a substantial decrease in BMI at three-year follow-up and higher EWL at one, two, and three years. However, LBSG procedures exhibited a higher incidence of post-operative regurgitation symptoms than LSG. No substantial differences were noted in BMI at six, 12, or 24 months, EWL at six months, operative time, bleeding, reflux, or overall complications.

Two-Year Results of the Banded Versus Non-banded Re-sleeve Gastrectomy as a Secondary Weight Loss Procedure After the Failure of Primary Sleeve Gastrectomy: a Randomized Controlled Trial

BACKGROUND

Insufficient weight loss or weight regain has been reported in up to 30% of patients after laparoscopic sleeve gastrectomy (LSG). Approximately 4.5% of patients who undergo LSG need revisional surgery for a dilated sleeve.

METHODS

This randomized controlled trial compared the outcomes between banded (BLSG) and non-banded re-LSG (NBLSG) after weight regain. Percentage excess body weight loss (%EWL), percentage total weight loss (%TWL), associated medical problems, gastric volume measurement, and endoscopy were measured preoperatively and 1 and 2 years postoperatively.

RESULTS

Both groups (25 patients each) achieved similar % EWL and %TWL at six months, one year, and two years postoperatively (%EWL 46.9 vs. 43.6, 83.7 vs. 86.3, and 85.7 vs. 83.9) (p= > 0.151) (%TWL 23.9 vs. 21.8, 43.1 vs .43.3, 44.2 vs. 42.2) (p=>0.342), respectively. However, the body mass index was significantly lower with BLSG (24.9 vs. NBLSG, 26.9). Both groups showed a significant reduction in stomach volume after two years (BLSG -248.4 mL vs. NBLSG -215.8 mL). Food tolerance (FT) scores were significantly reduced in both groups, whereby BSLG had significantly lower FT with an average of -1.1 point. No significant differences were observed regarding improvement of the associated medical problems after the first and two years after revisional LSG or the postoperative complications between both groups.

CONCLUSION

Laparoscopic re-LSG is feasible and safe with satisfactory outcomes in patients with weight regain after LSG who have gastric dilatation without reflux esophagitis. Both groups had comparable significant weight loss effects and improvement of associated medical problems. The BLSG tends to have a more stable weight loss after two years with a significantly lower BMI, lower stomach volume, and less weight regain. Food tolerance decreased in both groups but reduced more in the BLSG group. After a 2-year follow-up, we may regard both procedures are safe, with no significant differences in the occurrence of complications and nutritional deficits.