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Banded bypass

Banded bypass more effective in super obese

Image kindly provided and published with the permission of the Bariatec Corporation
20% more EWL banding the bypasswith super obese patients

Banded bypass procedure is safe and may provide better weight loss in super-obese patients, according to a paper, published in Surgery for Obesity and Related Diseases (SOARD). The researchers urged further prospective and long-term comparative studies of the banded bypass procedure to confirm its safety and whether it is superior to standard non-banded bypass. 

The study compared the outcomes between banded and non-banded LRYGB patients from the Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH. Between January 2007 and July 2010, 134 banded LRYGB were performed (55% female, mean age 45 years) and compared to a matched cohort of 134 concurrent non-banded LRYGB patients (67% female, mean age 45.4 years).

Patients who had a banded bypass, received an 8F, 6.5cm silastic ring placed around the proximal gastric pouch. Both cohorts were matched for age, BMI and anastomotic technique. Mean preoperative BMI was 54.6 and 52.8, respectively (p=0.084).

Results

At 24 months postoperatively, the average %EWL was 58.6% in banded bypass patients and 51.4% in the non-banded group (p=0.015) and the difference in EWL was more pronounced in super-obese patients than in those with BMI <50 (57.5% vs. 47.6%, p=0.003) vs. those with BMI <50 (62.9% vs. 57.9%, p=0.406).

There was no difference in early (19.4% vs. 19.4%) or late complications (10.4% vs. 13.4%, p=0.451) between banded and non-banded LRYGB patients.

There was no early (30-day) mortality and one late mortality case in each of the banded and non-banded bypass groups; neither were related to bariatric surgery in either patient.

Twenty six patients (19.4%) in each group developed an early postoperative complication and the rate of late morbidity was 10.4 vs. 13.4%, p=0.451, among banded-bypass and standard RYGB patients, respectively.

There were three band-related complications (2.2%): two occurrences of epigastric pain and dysphagia, and one presented with a stricture at the GJ anastomosis, distal to the level of the silicone ring.

Despite the positive results, the researchers said that many questions still need to be answered with regards to this procedure such as technical considerations (size of ring), position the ring, securing mechanism and materials.

“Our data suggests that after almost two years follow-up, on average, the banded RYGB yields superior weight loss,” they write. “Interestingly, the benefit in terms of %EWL applied only to super obese patients (BMI>50), who achieved a 10% greater EWL after banded than non-banded RYGB (57.5% vs. 47.6%, p=0.003).”

In conclusion, the authors write that the banded bypass can result in greater weight loss compared gastric bypass and that “the benefit appears to be specific to the super-obese bariatric population and also seems to be durable in the short-to-medium term.”

The study authors Drs Helen M Heneghan, Shorat Annaberdyev, Shai Eldar, Tomasz Rogula, Stacy Brethauer and Philip Schauer.

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