**Background:** Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide, but long-term weight regain occurs in approximately 28% of patients, with revision surgery required in 19.9%. Remnant gastric tube dilation is a proposed mechanism for weight regain. Some surgeons have proposed adding a non-adjustable band around the gastric tube (laparoscopic banded sleeve gastrectomy, LBSG) to stabilize the sleeve and improve long-term outcomes, analogous to banded Roux-en-Y gastric bypass. However, the benefits and risks of this modification remain controversial.
**Methods:** This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42021279242). Electronic databases searched included Cochrane Library, Embase, PubMed/MEDLINE, and Google Scholar up to August 10, 2021. Inclusion criteria were RCTs and high-quality controlled clinical trials comparing LBSG versus LSG in adults with BMI >35 kg/m². Eight comparative studies were included (3 RCTs, 4 CCTs, 1 prospective non-randomized trial), comprising 743 patients (352 LBSG, 391 LSG). Risk of bias was assessed using ROBINS-I for non-randomized studies and RoB2 for RCTs. Primary outcomes were anthropometric parameters (BMI and %EWL at 1, 3, and 5 years). Secondary outcomes included operative time, postoperative vomiting, food intolerance, de novo GERD, and complications requiring reoperation. Random effects models were used, with MD for continuous and OR for dichotomous outcomes.
**Key Results:** LBSG was associated with significantly lower BMI at 1 year (MD = -3.18; 95% CI [-5.45, -0.92], P = .006; 5 studies, 515 patients) and greater %EWL at 1 year (MD = 8.02; 95% CI [1.22, 14.81], P = .02; 4 studies, 329 patients) and at 3 years (MD = 10.60; 95% CI [5.60, 15.69], P < .001; 3 studies, 325 patients). Heterogeneity was moderate to high (I² = 79% for BMI at 1 year; I² = 84% for %EWL at 3 years). At 5 years, two studies reported significantly greater %EWL in the LBSG group (Lemmens: 86.7 ± 11.9 vs 57.8 ± 25, P = .003; Bhandari: 90.9% vs 85.27%, P < .001). No significant differences were found for operative time (MD = 1.23; 95% CI [-4.71, 7.17], P = .69), food intolerance (OR = 1.72; 95% CI [0.84, 3.49], P = .14), postoperative vomiting (OR = 2.10; 95% CI [0.69, 6.35], P = .19), or de novo GERD (OR = 0.65; 95% CI [0.34, 1.26], P = .2). Major postoperative complications requiring reoperation were not significantly different between groups. Comorbidity resolution data were not standardized and could not be pooled.
**Clinical Implications:** This meta-analysis suggests that adding a non-adjustable band during sleeve gastrectomy may improve short- and mid-term weight loss outcomes without significantly increasing operative time, food intolerance, vomiting, or de novo GERD. The band's primary mechanism may be preventing gastric tube dilation rather than providing additional restriction. However, the certainty of evidence was rated as low for anthropometric outcomes and very low for secondary outcomes due to risk of bias, heterogeneity, and imprecision. The authors note that band-related complications (erosion, slippage) were rare, with only one reported erosion. Important limitations include the small number of RCTs, non-standardized surgical techniques (band type, circumference 6.5-7.5 cm, placement 4-6 cm from gastroesophageal junction), variable follow-up, and lack of standardized comorbidity reporting. The authors conclude that additional large RCTs with longer follow-up are needed before LBSG can be routinely recommended as a primary procedure.