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Capella procedure

Adding banding to bypass increases efficacy

Placing a gastric band at the same time as a bypass may result in greater weight loss
60-month results showed increased weight loss approaching, but not reaching, statistical significance when band added

Banded long-limb gastric bypass may result in greater weight loss over time in superobese patients than the traditional, non-banded gastric bypass, according to research reported at the annual meeting of the American Society for Metabolic and Bariatric Surgery.

According to Dr Jenny Choi, Columbia University Medical Center (New York), the current National Institutes of Health guidelines have recommended bariatric surgery for patients with a BMI of over 40, or BMI over 35 with significant co-morbidities. However, some preliminary studies have shown that patients with a BMI that does not meet these criteria, could also experience similar weight loss and the benefits associated with it.


A total of 90 patients with BMI over 50 were enrolled in the study from June 2001 through July 2005. 46 were randomly assigned to the undergo the Capella procedure, with the remaining patients undergoing a Roux-en-Y gastric bypass.

The same surgeon performed all of the surgeries, with no significant between-group differences in patient BMI, age, or comorbidities at baseline.


Outcomes


At 12, 24, 26, and 48 months, the percentage of excess weight loss for the banded and non-banded 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 was higher in the banded group, at 49%, than the 37% observed in the non-banded group. Whilst the failure rate, defined in the study as less than 50% EWL was 10% in the banded group, compared with 15.7% in the non-banded group. Peak weight loss, weight regain began at 18 months in the non-banded group and at 24 months in the banded group. However, there was a trend toward weight regain at the five-year follow-up in both groups.


There were no reported instances of death in either group and there were no significant differences between groups in the rates of postoperative complications. In regard to device complications, there were no cases of band erosion or slippage, and although the banded group reported more postoperative emesis and food intolerance. 



Limitations


Although Choi acknowledged that the power of the study’s statistical analysis was limited by its small size, and five-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. “Further follow-up of a larger cohort is needed to better assess the long-term outcomes of the banded and non-banded procedures,” she said.

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American Society for Metabolic and Bariatric Surgery

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