Patients with Severe Obesity Undergoing Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy: A Systematic Review and an Updated Meta-Analysis.

IF 3.1 3区医学 Q1 SURGERY Obesity Surgery Pub Date : 2025-03-01 Epub Date: 2025-02-18 DOI:10.1007/s11695-025-07743-6

Pedro Bicudo Bregion, André Milani Reis, Rafaela Hamada Jucá, Josélio Rodrigues de Oliveira-Filho, Giulia Almiron da Rocha Soares, Everton Cazzo, Victor Kenzo Ivano

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Abstract

Background: Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) contributes significantly to higher weight loss at 6 to 12 months when compared to Laparoscopic Sleeve Gastrectomy (LSG) in patients with severe obesity (SO-body mass index (BMI) ≥ 50 kg/m²). However, there is still no consensus regarding the best procedure in terms of mortality and complication rates. We performed a systematic review and meta-analysis to compare the complication rates between these two surgical procedures.

Methods: PubMed, EMBASE, and Cochrane Central were searched for studies that compared LRYGB and LSG in SO patients. We pooled outcomes for mortality and complications, defined as bleeding, cardiovascular events, conversion to open procedure, and a composite endpoint of leak, abscess, fistulas, and reoperation. Length of stay and operative time were also pooled. A random-effects model was used, and statistical analyses were performed using R version 4.4.0.

Results: A total of 156,767 patients from 28 observational studies were included, of whom 79,324 (50.6%) underwent LRYGB and 77,443 (49.4%) LSG. Length of stay (MD 0.45; 95% CI 0.42-0.48; P < 0.01) and operative time (MD 58.88; 95% CI 37.88-79.87; P < 0.01) were lower in the LSG group. Overall, there was no difference in mortality (OR 1.28; 95% CI 0.80-2.04; P = 0.311) and in complication rates (OR 1.22; 95% CI 0.85-1.76; P = 0.287). A subgroup analysis showed lower conversion to open procedure for patients who underwent LSG (OR 2.75; 95% CI 1.90-3.98; P < 0.001), and no difference was noted in bleeding (OR 0.98; 95% CI 0.47-2.07; P = 0.965), cardiovascular events (OR 0.99; 95% CI 0.43-2.29; P = 0.983), and a composite endpoint of leak, abscess, and fistulas (OR 0.82; 95% CI 0.67-1.01; P = 0.066).

Conclusion: Our meta-analysis suggests that there is no difference in mortality and complication rates between the two groups. However, length of stay and operative time were lower in SO patients who underwent LSG.

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重度肥胖患者行Roux-En-Y胃旁路与袖式胃切除术：一项系统综述和最新荟萃分析。

背景：在体重指数(BMI)≥50 kg/m2的重度肥胖患者中，腹腔镜Roux-En-Y胃旁路术（LRYGB）比腹腔镜袖式胃切除术（LSG）在6 - 12个月时的减重效果显著。然而，就死亡率和并发症发生率而言，关于最佳手术方法仍未达成共识。我们进行了系统回顾和荟萃分析来比较这两种手术的并发症发生率。方法：检索PubMed、EMBASE和Cochrane Central中比较SO患者LRYGB和LSG的研究。我们汇总了死亡率和并发症的结果，定义为出血、心血管事件、转开腹手术，以及泄漏、脓肿、瘘管和再手术的复合终点。统计住院时间和手术时间。采用随机效应模型，采用R 4.4.0版本进行统计分析。结果：28项观察性研究共纳入156767例患者，其中79324例（50.6%）接受了LRYGB， 77443例（49.4%）接受了LSG。住院时间(MD 0.45；95% ci 0.42-0.48；结论：我们的荟萃分析表明，两组之间的死亡率和并发症发生率没有差异。然而，接受LSG的SO患者的住院时间和手术时间较低。

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来源期刊

Obesity Surgery 医学-外科

CiteScore

5.80

自引率

24.10%

发文量

567

审稿时长

3-6 weeks

期刊介绍： Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.