Sleeve gastrectomy (SG) is one of the most common bariatric procedures performed worldwide. Use of a minimizer ring after sleeve gastrectomy has been contentious, with questions remaining if it truly enhances outcomes by limiting dilation of the sleeve over time and reducing weight regain. Simulation cohorts consisting of 132 patients with ring and 125 without were created from aggregate data published in two Open Access studies – a propensity matched retrospective cohort study (PMC12690876) and randomized controlled trial (PMC10810940) – to objectively compare weight loss and excess weight loss (%EWL), change in BMI, loss of resolution of comorbidities, and complication rates through 36 months. Analysis was performed with adaptive testing (Student's t-test or Mann-Whitney U test based on Shapiro-Wilk test for normality) and multivariate ordinary least squares (OLS) regression with adjustment for patient age, baseline BMI, sex, and diabetes at baseline. At 36 months, the ring group had significantly greater weight loss (%TWL 49.8% vs 37.3%; %EWL 105.7% vs 79.2%; p0.0001) and a significantly lower mean BMI (23.7 vs 29.7 kg/m²; p0.0001) with no significant difference in rate of comorbidity resolution among hypertension, diabetes, and dyslipidemia. However, patients in the ring group experienced significantly more regurgitation (59% vs 23%, p0.01). Our data demonstrates that minimizer ring augmentation improves long-term weight loss outcomes after sleeve gastrectomy but leads to significantly higher rates of regurgitation.