LAS VEGAS (EGMN) – Banded long-limb gastric bypass may result in greater weight loss over time in superobese patients than the traditional, nonbanded gastric bypass, a study has shown.
Data from a prospective, randomized trial comparing the long-term outcomes of the two procedures showed similar initial weight loss for patients in the two groups but a trend toward better maintenance of weight loss at 5 years in the banded group, Dr. Jenny Choi reported at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
In addition, patients in the banded group were more likely to experience resolution of gastroesophageal reflux disease relative to those who underwent the less restrictive procedure, she said, noting that there were no differences in the degree of resolution of other comorbidities.
Of the 90 patients with body mass index (BMI) greater than 50 kg/m2 who were enrolled in the study from June 2001 through July 2005, 46 were randomly assigned to the undergo the banded gastric bypass – known as the Capella procedure – which involved the placement of a 1.5–by-5.5--cm polypropylene band around the proximal gastric pouch. The remaining 44 patients underwent the conventional Roux-en-Y gastric bypass, Dr. Choi explained. All of the surgeries were performed by the same surgeon, and there were no significant between-group differences in patient BMI, age, or comorbidities at baseline, she said.
Dr. Choi and her colleagues at Columbia University Medical Center in New York collected data on weight loss, improvement or resolution of comorbidities, and complications reported for all of the patients at 12, 24, 36, 48, and 60 months.
“At each of the time points, the banded group consistently had better weight loss, although the difference was not statistically significant,” she said. At 12, 24, 26, and 48 months, the percentage of excess weight loss for the banded and nonbanded groups, respectively, was 63.9% and 56.9%; 65.9% and 59.8%; 63.5% and 55.8%; and 55.3% and 42.6%. At 60 months, the between-group difference in percentage of excess weight lost (55.4% vs. 47.5%) approached but did not reach statistical significance in the banded group vs. the nonbanded group.
The number of patients who reached a BMI of less than 35 kg/m2 was higher in the banded group, at 49%, than the 37% observed in the nonbanded group, Dr. Choi noted. Additionally, “the failure rate [defined as less than 50% of excess weight loss] was 10% in the banded group, compared with 15.7% in the nonbanded group,” she said.
With respect to peak weight loss, weight regain began at 18 months in the nonbanded group and at 24 months in the banded group, said Dr. Choi, who noted a trend toward weight regain in both groups at the 5-year follow-up.
No patient in either of the study groups died, and there were no significant differences between groups in the rates of postoperative complications, Dr. Choi reported. There were no cases of band erosion or slippage, and although the banded group reported more postoperative emesis and food intolerance, “all were treated conservatively and did not require invasive intervention,” she said.
Although the power of the study’s statistical analysis was limited by its small size, and 5-year follow-up data were only available for approximately 25% of the overall study population, the findings suggest that the banded procedure is a reasonable therapeutic option for the superobese population, and it may result in better maintenance of weight loss over time, said Dr. Choi. “Further follow-up of a larger cohort is needed to better assess the long-term outcomes of the banded and nonbanded procedures,” she said.
Dr. Choi reported having no financial conflicts of interest. Study coauthor Dr. Marc Bessler disclosed relationships with Ethicon EndoSurgery Inc., Covidien, and Olympus America Inc.