ScientificWriting Corporation, Houston, Texas.
Department of Surgery, University of Oklahoma, College of Medicine, Tulsa, Oklahoma.
Surg Obes Relat Dis. 2019 May;15(5):688-695. doi: 10.1016/j.soard.2019.02.011. Epub 2019 Apr 3.
Bariatric surgery is remarkably effective in achieving weight loss and improving obesity-related co-morbidities; however, efforts still continue to improve its long-term outcomes. Particularly, banded Roux-en-Y gastric bypass (RYGB) has been scrutinized in comparison to standard (nonbanded) RYGB in terms of benefits and postoperative complications.
This study aims to compare the safety and efficacy of banded versus nonbanded RYGB.
Meta-analysis of randomized controlled trials (RCTs).
A meta-analysis of high-quality studies that compared banded and nonbanded RYGB was conducted through February 2019 by systematically searching multiple electronic databases. Published RCTs comparing these 2 procedures were included to pool the data on excess weight loss, food tolerability, and postoperative complications.
Three RCTs were eligible to be included in this meta-analysis, comprising a total of 494 patients (247 in each group). Two of the RCTs provided 2-year postoperative data, and 1 study reported 5-year outcome. Age ranged from 21 to 50 years, and body mass index ranged from 42 to 65 kg/m. Percentage of excess weight loss was significantly greater with banded RYGB than with nonbanded RYGB (mean difference 5.63%; 95% CI 3.26-8.00; P < .05). Postoperative food intolerance, emesis, and dysphagia were more common after banded RYGB (odds ratio 3.76; 95% CI 2.27-6.24; P < .001). Nevertheless, major postoperative complications did not significantly differ between the 2 groups.
Findings of this meta-analysis of RCTs indicate that in a medium-term follow-up, excess weight loss with banded RYGB would be 5% greater than that with the nonbanded RYGB (about 1 point difference in body mass index) at the expense of more food intolerance and postoperative vomiting; however, the frequency of postoperative complications would not be significantly different.
减重手术在减轻体重和改善肥胖相关合并症方面效果显著；然而，人们仍在努力改善其长期效果。特别是带袖套的 Roux-en-Y 胃旁路术（RYGB）与标准（无袖套）RYGB 相比，其获益和术后并发症一直备受关注。
本研究旨在比较带袖套和无袖套 RYGB 的安全性和有效性。
荟萃分析随机对照试验（RCT）。
通过系统搜索多个电子数据库，于 2019 年 2 月前对比较带袖套和无袖套 RYGB 的高质量研究进行荟萃分析。纳入比较这两种手术的已发表 RCT，以汇总关于超重减轻、食物耐受性和术后并发症的数据。
有 3 项 RCT 符合纳入本荟萃分析的条件，共纳入 494 例患者（每组 247 例）。其中 2 项 RCT 提供了 2 年的术后数据，1 项研究报告了 5 年的结果。年龄范围为 21-50 岁，体重指数范围为 42-65 kg/m²。带袖套 RYGB 的超重减轻百分比明显大于无袖套 RYGB（平均差异 5.63%；95%CI 3.26-8.00；P<.05）。带袖套 RYGB 后更常见术后食物不耐受、呕吐和吞咽困难（比值比 3.76；95%CI 2.27-6.24；P<.001）。然而，两组间主要术后并发症无显著差异。
这项 RCT 荟萃分析的结果表明，在中期随访中，带袖套 RYGB 的超重减轻量将比无袖套 RYGB 多 5%（体重指数差异约 1 分），但食物不耐受和术后呕吐的发生率更高；然而，术后并发症的频率并无显著差异。
