Abstract Introduction Laparoscopic ring-augmented sleeve gastrectomy has been shown to provide better weight loss outcomes compared to Laparoscopic non-augmented sleeve gastrectomy. Studies have demonstrated that patients undergoing ring-augmented sleeve achieve higher excess weight loss (EWL) and total weight loss (TWL) in both short-term and mid-term follow-up periods. Despite its effectiveness, ring-augmented sleeve is associated with several complications that may necessitate ring removal. Patients and methods A retrospective cohort study was performed involving 75 patients with morbid obesity. The surgical intervention consisted of laparoscopic ring-augmented sleeve gastrectomy utilizing the MiniMizer Gastric Ring. Peri-gastric dissection was performed at a distance of 4–5 cm from the gastroesophageal junction, and a MiniMizer Gastric Ring (Bariatric Solutions International, Switzerland) was positioned at a diameter of 7.5 cm in fifty cases and at a diameter of 7 cm in twenty-five cases. Non-absorbable sutures were utilized to secure the ring to the stomach, passing through the ring's integrated holes. In our report, approximately 6.6% of cases required reoperation to remove the ring, and in one instance, conversion to Roux-en-Y gastric bypass was deemed necessary. Case scenarios Case 1; ten weeks post ring-augmented sleeve, she experienced significant nausea and vomiting that lasted for two weeks. The patient was promptly rehydrated and underwent a computed tomography (CT) scan of the abdomen with oral contrast that showed ring in place. A combined Laparoscopic and Endoscopic approach was performed at the same which showed a gastric bezoar that was removed endoscopically and the ring was removed laparoscopically. Case 2; 18 months after surgery, she became pregnant, with the initial three months passed without complications. Unfortunately, she experienced an IUFD, accompanied by persistent vomiting lasting for one week. The patient also developed HELLP syndrome. A barium study was subsequently performed showed slipped ring with gastric outlet obstruction. After adequate preparation and resuscitation of the patient, a concomitant laparoendoscopic approach was performed, confirming the diagnosis. A decision was made to cut the ring. Case 3; 18 months postoperative, she complained of repeated vomiting and food intolerance. A CT virtual gastroscopy was performed and showed a displaced ring with suspected erosion. Immediate endoscopy revealed intact mucosa without any signs of ring erosion with a partial gastric obstruction at the mid of the gastric tube. Laparoscopic exploration was performed and the ring was removed. Case 4; 28 months postoperatively, she complained of food intolerance and insisted on getting rid of the ring. Laparoscopic exploration was performed and the ring was safely removed. Case 5; She has reported worsening reflux symptoms. An upper endoscopy showed mild esophagitis. Intensive dietary counselling along with medical treatment was initiated, but unfortunately, the patient developed significant food intolerance and persistent reflux. She lost follow-up and was managed by another team, where ring removal and Roux-en-Y gastric bypass were performed. Conclusion Laparoscopic ring-augmented sleeve gastrectomy effectively induces significant weight loss but can cause complications like regurgitation, ring erosion, and slippage, which may require ring removal. The decision to remove the ring should be individualized.
Elghadban et al. (Thu,) studied this question.