Department of Surgery, Rush University Medical Center, 1725 W Harrison Street, Suite 250, Chicago, IL, 60612, USA.
Office of Surgical Research, Department of Surgery, Rush University Medical Center, Chicago, IL, USA.
Obes Surg. 2019 Feb;29(2):420-425. doi: 10.1007/s11695-018-3538-8.
Laparoscopic adjustable gastric banding (LAGB) is associated with high long-term failure rates, often requiring conversion to an alternative bariatric procedure. The most efficacious procedure after failed LAGB is subject to debate. Our objective was to compare 12-month weight loss following laparoscopic sleeve gastrectomy (LSG) vs. laparoscopic Roux-en-Y gastric bypass (LRYGB) performed for insufficient weight loss or weight regain after LAGB.
A systematic search was conducted in PubMed and Medline for English language studies comparing weight loss after a conversion surgery for failed gastric banding. We examined studies with patients who had at least 1-year follow-up and included conversions to both LSG and LRYGB. A fixed effects model was created, and variance measures were calculated to measure heterogeneity. Both were analyzed for significance. All statistical analyses were conducted with the "meta" package in R 3.3.2.
The initial search produced 17 studies. Six studies, consisting of 205 LSG and 232 LRYGB patients, met our inclusion criteria and were included in the review. Heterogeneity among studies was high (Q = 23.1; p < 0.001). There was no statistically significant difference in weight loss after 12 months between the groups (p = 0.14).
It remains unknown which conversion procedure is more appropriate to perform after a failed gastric band in order to achieve the highest weight loss potential. In our meta-analysis, there was no difference in weight loss after 12 months in patients who were converted to LSG or LRYGB. Further studies and longer follow-up comparisons are required before firm conclusions can be drawn.
腹腔镜可调节胃束带术（LAGB）与较高的长期失败率相关，通常需要转换为替代减重手术。在 LAGB 失败后，最有效的手术方法存在争议。我们的目的是比较腹腔镜袖状胃切除术（LSG）与腹腔镜 Roux-en-Y 胃旁路术（LRYGB）治疗 LAGB 后体重减轻不足或体重反弹的 12 个月减重效果。
在 PubMed 和 Medline 中进行了系统检索，以查找比较 LAGB 失败后转换手术减重效果的英文文献。我们检查了至少有 1 年随访的患者，并包括了 LSG 和 LRYGB 两种转换术式的研究。创建了固定效应模型，并计算方差度量以测量异质性。均进行了显著性分析。所有统计分析均使用 R 3.3.2 中的“meta”包进行。
最初的搜索产生了 17 项研究。6 项研究（包括 205 例 LSG 和 232 例 LRYGB 患者）符合纳入标准并纳入综述。研究之间存在高度异质性（Q=23.1；p<0.001）。两组患者 12 个月后的减重效果无统计学差异（p=0.14）。
对于 LAGB 失败后为达到最大减重潜力而选择哪种转换手术仍然未知。在我们的荟萃分析中，LSG 或 LRYGB 转换的患者在 12 个月后的减重效果没有差异。需要进一步研究和更长时间的随访比较，才能得出确定的结论。
