Technical Considerations of Ring-Augmented Laparoscopic Sleeve Gastrectomy: A Step-by-step Guide for Ring Placement by Various Experts

Key Points1.The ring should be placed 3-5 cm below the gastroesophageal junction and not applied too tightly to avoid constant pressure on the gastric wall, which may cause dysphagia, facilitate migration, or cause complications like dysphagia or ischemia.2. Sutures (preferably non-absorbable) are essential for long-term fixation, preventing ring slippage.3.In the pars-flaccida technique, reducing excess fat between the stomach and the ring ensures optimal positioning and minimizes the risk of slippage.