Yung Lee1,2, Aristithes G Doumouras1,2, James Yu1,2, Ishan Aditya3, Scott Gmora1,2, Mehran Anvari1,2, Dennis Hong1,2. 1. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. 2. Centre for Minimal Access Surgery (CMAS), St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada. 3. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: The aim of this study was to compare weight loss, obesity-related comorbidities, and biochemical outcomes of LSG versus LRYGB through a meta-analysis of randomized controlled trials (RCTs). SUMMARY OF BACKGROUND DATA: LSG and LRYGB are the 2 most commonly performed bariatric surgeries for the treatment of obesity. The comparative outcomes of the 2 surgeries is a topic of ongoing debate and medium-term outcomes remain uncertain. METHODS: A search for RCTs comparing LRYGB versus LSG was conducted. Pooled outcomes between 2 procedures were compared using pairwise random-effects meta-analysis at 1, 3, and 5-year follow-up time points. Grading of recommendations, assessment, development, and evaluation was used to assess certainty of evidence. RESULTS: Thirty-three studies involving 2475 patients were included. LRYGB resulted in greater loss of body mass index compared to LSG at 1 year [mean difference -1.25 kg/m2, 95% confidence interval (CI) -2.01 to -0.49, P = 0.001; moderate certainty of evidence] which persisted at 3 years, but there was insufficient evidence at 5 years. Resolution of dyslipidemia was higher for LRYGB than LSG at 1 year (risk ratio 0.58, 95% CI 0.46-0.73, P < 0.001; moderate certainty of evidence) and 5 years (risk ratio 0.68, 95%CI 0.46-0.99, P = 0.04; low certainty of evidence). There was no difference between LRYGB and LSG for remission of type 2 diabetes, hypertension, and hemoglobin A1c, fasting insulin, homeostatic model assessment of insulin resistance, high-density lipoprotein, and the rate of 30-day major and minor complications. CONCLUSIONS: There are insufficient data from RCTs to draw any conclusions regarding the long-term comparative effectiveness beyond 3 years between LRYGB and LSG.
OBJECTIVE: The aim of this study was to compare weight loss, obesity-related comorbidities, and biochemical outcomes of LSG versus LRYGB through a meta-analysis of randomized controlled trials (RCTs). SUMMARY OF BACKGROUND DATA: LSG and LRYGB are the 2 most commonly performed bariatric surgeries for the treatment of obesity. The comparative outcomes of the 2 surgeries is a topic of ongoing debate and medium-term outcomes remain uncertain. METHODS: A search for RCTs comparing LRYGB versus LSG was conducted. Pooled outcomes between 2 procedures were compared using pairwise random-effects meta-analysis at 1, 3, and 5-year follow-up time points. Grading of recommendations, assessment, development, and evaluation was used to assess certainty of evidence. RESULTS: Thirty-three studies involving 2475 patients were included. LRYGB resulted in greater loss of body mass index compared to LSG at 1 year [mean difference -1.25 kg/m2, 95% confidence interval (CI) -2.01 to -0.49, P = 0.001; moderate certainty of evidence] which persisted at 3 years, but there was insufficient evidence at 5 years. Resolution of dyslipidemia was higher for LRYGB than LSG at 1 year (risk ratio 0.58, 95% CI 0.46-0.73, P < 0.001; moderate certainty of evidence) and 5 years (risk ratio 0.68, 95%CI 0.46-0.99, P = 0.04; low certainty of evidence). There was no difference between LRYGB and LSG for remission of type 2 diabetes, hypertension, and hemoglobin A1c, fasting insulin, homeostatic model assessment of insulin resistance, high-density lipoprotein, and the rate of 30-day major and minor complications. CONCLUSIONS: There are insufficient data from RCTs to draw any conclusions regarding the long-term comparative effectiveness beyond 3 years between LRYGB and LSG.
Authors: Kelly G H van de Pas; Daniëlle S Bonouvrie; Loes Janssen; Marleen M Romeijn; Arijan A P M Luijten; Wouter K G Leclercq; François M H van Dielen Journal: Obes Surg Date: 2022-01-29 Impact factor: 4.129
Authors: Rinki Murphy; Lindsay D Plank; Michael G Clarke; Nicholas J Evennett; James Tan; David D W Kim; Richard Cutfield; Michael W C Booth Journal: Diabetes Care Date: 2022-07-07 Impact factor: 17.152