Osland Emma, Yunus Rossita M, Khan Shahjahan, Memon Breda, Memon Muhammed A
*Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston †Department of Human Movements and Nutrition ¶Mayne Medical School, School of Medicine, University of Queensland, Brisbane §School of Agricultural, Computational and Environmental Sciences, International Centre for Applied Climate Sciences and Centre for Health Sciences Research, University of Southern Queensland, Toowoomba ∥Sunnybank Obesity Centre South & East Queensland Surgery (SEQS), McCullough Centre, Sunnybank #Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld, Australia ‡Institute of Mathematical Sciences, University of Malaya, Kuala Lumpur, Malaysia **Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK.
Surg Laparosc Endosc Percutan Tech. 2016 Jun;26(3):193-201. doi: 10.1097/SLE.0000000000000279.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG), have been proposed as cost-effective strategies to manage obesity-related chronic disease. The objectives of this meta-analysis and systematic review were to analyze the "late postoperative complication rate (>30 days)" for these 2 procedures.
Randomized controlled trials (RCTs) published between 2000 and 2015 comparing the late complication rates, that is, >30 days following LVSG and LRYGB in adult population (ie, 16 y and above) were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included mortality rate, major and minor complications, and interventions required for their management and readmission rates. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran Q statistic and I index. The meta-analysis was prepared in accordance with the Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines.
Six RCTs involving a total of 685 patients (LVSG, n=345; LRYGB, n=340) reported late major complications. A nonstatistical reduction in relative odds favoring the LVSG procedure was observed [odds ratio (OR), 0.64; 95% confidence interval (CI), 0.21-1.97; P=0.4]. Four RCTs representing 408 patients (LVSG, n=208; LRYGB, n=200) reported late minor complications. A nonstatistically significant reduction of 36% in relative odds favoring the LVSG procedure was observed (OR, 0.64; 95% CI, 0.28-1.47; P=0.3). A 37% relative reduction in odds was observed in favor of the LVSG for the need for additional interventions to manage late postoperative complications that did not reach statistical significance (OR, 0.63; 95% CI, 0.19-2.05; P=0.4). No study specifically reported readmissions required for the management of late complication.
This meta-analysis and systematic review of RCTs shows that the development of late (major and minor) complications is similar between LVSG and LRYGB procedures, 6 months to 3 years postoperatively, and they do not lead to higher readmission rate or reoperation rate for either procedure. However longer-term surveillance is required to accurately describe the patterns of late complications in these patients.
腹腔镜Roux-en-Y胃旁路术（LRYGB）和腹腔镜垂直袖状胃切除术（LVSG）已被视为治疗肥胖相关慢性病的经济有效策略。本荟萃分析和系统评价的目的是分析这两种手术的“术后晚期并发症发生率（>30天）”。
从PubMed、Medline、Embase、科学引文索引、现刊目次和Cochrane数据库中选取2000年至2015年间发表的比较成人（即16岁及以上）LVSG和LRYGB术后晚期并发症发生率（即术后>30天）的随机对照试验（RCT）。分析的结局变量包括死亡率、主要和次要并发症及其处理所需的干预措施以及再入院率。采用随机效应模型计算二分类和连续数据的效应量。通过Cochran Q统计量和I指数确定这些试验结局变量之间的异质性。本荟萃分析按照系统评价和荟萃分析的首选报告规范进行。
六项RCT共纳入685例患者（LVSG组345例；LRYGB组340例），报告了术后晚期主要并发症。观察到有利于LVSG手术的相对比值有非统计学意义的降低[比值比（OR），0.64；95%置信区间（CI），0.
