Long-term outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: Results from a meta-analysis of randomized controlled trials.

Abstract

BACKGROUND\nLaparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass (LRYGB) are 2 widely used procedures performed in bariatric surgery. However, their long-term weight loss effects have not been well compared.\n\n\nOBJECTIVES\nTo evaluate the long-term outcome of 2 procedures for treating morbid obesity.\n\n\nSETTING\nThe gastrointestinal surgery center, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People s Hospital.\n\n\nMETHODS\nThree electronic databases, PubMed, CNKI, and EMBASE, were searched ending in September 2018. Eligible studies were prospective randomized controlled trials.\n\n\nRESULTS\nOf 15 randomized controlled trials studies, 1381 cases were included, 697 were randomly divided into the laparoscopic sleeve gastrectomy group and 684 to the LRYGB group. A statistically significant percent excess weight loss reduction in weighted mean difference was observed in LRYGB group at 5 years (weighted mean difference\u202f=\u202f-8.9, 95% confidence interval [CI]\u202f=\u202f-13.08 to -4.73, P < .0001), and at 3 years (weighted mean difference\u202f=\u202f-11.96, 95% CI\u202f=\u202f-17.62 to -6.30, P < .0001). However, there was not any statistically difference between the 2 procedures in <3 years. The total complication of the LSC group were less than that of the LRYGB groups (odds ratio\u202f=\u202f.52, 95%CI\u202f=\u202f.35-.76, P\u202f=\u202f.0007). This meta-analysis showed that the LRYGB procedure could reduce gastrointestinal reflux disease (odds ratio\u202f=\u202f.26, 95%CI\u202f=\u202f.11-.61, P\u202f=\u202f.002); however, no statistically significant differences were found in type 2 diabetes, hypertension, dyslipidemia, and sleep apnea.\n\n\nCONCLUSIONS\nThis meta-analysis showed that significantly greater in percent excess weight loss after 5 years of LRYGB treatment; however, it seems to have a higher incidence of total complications.