Evaluating The Impact of Ring Augmentation In Sleeve Gastrectomy: A Retrospective Propensity-weighted Cohort Study

Sleeve gastrectomy (SG) is the most commonly performed metabolic surgery for obesity but is associated with long-term recurrent weight gain (RWG) and recurrence of comorbidities. Ring-augmented sleeve gastrectomy (RASG) has been proposed to improve weight durability by preventing gastric dilation and loss of restriction. This retrospective propensity-weighted cohort study compared outcomes of RASG and non-ring-augmented SG (NRASG) over two years in patients with morbid obesity. A total of 1,392 SG cases performed between 2021 and 2022 were reviewed, and after propensity score weighting, 132 RASG and 125 NRASG patients were analyzed. RASG was associated with significantly higher total and excess weight loss at two years (TWL: 47.4% vs. 38.5%; EWL: 102.8% vs. 82.0%; p < 0.001) and a complete absence of RWG, compared to a 5.6% recurrence rate in the NRASG group. Comorbidity resolution rates and nutritional deficiencies were similar across groups, while ring-related complications were rare and manageable. Endoscopic evaluation at one year showed no significant difference in GERD incidence. These findings suggest that RASG provides more durable weight loss without added morbidity compared to NRASG. Further prospective studies incorporating patient-reported outcomes and physiologic assessments are warranted to validate long-term benefits and safety.