Introduction <p>Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure. Although ring-augmented LSG reportedly improves long-term weight-loss outcomes, some are concerned about potential complications related to the foreign body. Therefore, this study aimed to examine 2 years of follow-up of banded sleeve with the patient’s own tissue, naturally banded LSG.</p> Methods <p>This prospective randomized controlled clinical trial enrolled 80 patients. It was conducted at a university hospital between November 2022 and January 2025. Patients were randomly assigned to two equal groups: Group 1, LSG plus banding using the Teres ligament or a tight omental flap, and Group 2, LSG without banding. Patients were followed up for at least 2 years.</p> Results <p>The mean follow-up period was 25.5 months. At 2 years, the mean gastric volume was significantly smaller in Group 1 (142.3 mL) than in Group 2 (218.7 mL, <i>p</i>= 0.000). Additionally, the mean percentage of excess weight loss (%EWL) was significantly higher in Group 1 (87.0%) than in Group 2 (81.8%, <i>p</i>= 0.000). Moreover, the mean percentage of total weight loss (%TWL) was significantly higher in Group 1 (42.0%) than in Group 2 (38.0%, <i>p</i>= 0.034). Finally, the mean food tolerance score was significantly lower in Group 1 (21.5) than in Group 2 (22.9, <i>p</i>= 0.000).</p> Conclusions <p>Based on 2 years of follow-up, LSG with natural banding was associated with minimal gastric pouch dilatation and greater weight loss than non-banded LSG. However, long-term follow-up data are needed. </p> Graphical Abstract <p></p>