Evaluation of Laparoscopic Sleeve Gastrectomy With a Natural Band (Sewefy Wrap): Results From a Prospective, Randomized Controlled Trial.

Background Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery procedure. Adding a synthetic band to LSG is reported to decrease the incidence of weight regain. However, the synthetic material has many drawbacks. This study aimed to evaluate the use of a natural flap as a band with LSG. Methods This study was a prospective, randomized controlled trial and included 80 patients with morbid obesity. It was conducted in the Minia University Hospital between November 2022 and February 2024. Participants were equally and randomly assigned to two groups. In one group, the patients underwent LSG and banding using either the Teres ligament (the round ligament of the liver) or a tight omental flap. In the second group, the standard LSG procedure was carried out without any band.  Results The mean follow-up period was 13.5 months. At one year, the mean gastric volume was significantly less in the banded group (110.7 ml) than in the non-banded group (147.3 ml; p=0.000), and the mean % excess weight loss (EWL) was significantly higher in former (85.8%) than in the latter group (79.5; p=0.002). Similarly, the mean % total weight loss (TWL) was also significantly higher in the banded group (41.3%) than in the non-banded group (36.7%; p=0.010). Moreover, the mean score of food tolerance was 20.8 in the banded group versus 21.1 in the non-banded one (p=0.172). Conclusions LSG along with the a natural band using a nearby flap like the round ligament of the liver or an omental flap leads to better weight loss than non-banded LSG. It is also associated with minimal pouch dilatation and a low complication rate. The use of this technique is, hence, a promising procedure that minimizes sleeve pouch dilatation (the main cause of weight regain after LSG) without any extra cost or complications associated with a foreign body. However, long-term follow-up for this procedure is needed.