Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea.
Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.
Obes Surg. 2019 Jul;29(7):2180-2190. doi: 10.1007/s11695-019-03831-6.
The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively.
We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM).
Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = - 0.2% [- 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3-5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB.
RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.
各种减肥手术的疗效尚未完全阐明。我们旨在全面评估各种减肥手术的疗效和安全性。
我们检索了关于减肥手术疗效的随机对照试验。进行网络荟萃分析以确定超重体重减轻百分比（%EWL）和糖尿病缓解率。
在 45 项研究中，有 33 项和 24 项分别提供了 %EWL 和糖尿病缓解率的数据。手术后 6 个月，胆胰分流十二指肠转位术（BPD-DS）、胃旁路术（RYGB）和袖状胃切除术（SG）在 %EWL 方面优于标准护理（平均差异 [MD]，[95%置信区间 [CI]]：BPD-DS，38.2%[7.3%，69.1%]；RYGB，32.1%[3.1%，61.1%]；SG，32.5%[5.5%，59.5%]）。然而，可调胃束带术并不优于标准护理（MD [95%CI] = -0.2%[-19.6%，19.2%]）。1 年后，所有减肥手术均优于标准护理。3 年后，RYGB 和 SG 与标准护理相比具有更好的疗效（MD [95%CI]：RYGB，45.0%[21.8%，68.2%]；SG，39.2%[15.2%，63.3%]）。关于手术后 3-5 年的糖尿病缓解率，BPD-DS、RYGB 和 SG 优于标准护理。与 RYGB 相比，SG 患者疝、梗阻/狭窄、出血和溃疡的发生率较低。
RYGB 和 SG 对超重体重减轻百分比和糖尿病缓解率均具有出色的长期效果。此外，SG 的不良事件风险相对低于 RYGB。
