Barros Fernando de, Negrão Mayara Galisse, Negrão Giovana Galisse
Department of General and Specialized Surgery, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil.
Medical College, University of Franca, Franca, SP, Brazil.
Arq Bras Cir Dig. 2019 Dec 20;32(4):e1474. doi: 10.1590/0102-672020190001e1474. eCollection 2019.
Bariatric surgery is currently the gold standard treatment for obesity. The two most accomplished surgeries are the Roux-en-Y gastric bypass and the sleeve gastrectomy, and controversies exist in which is better.
To compare the two techniques in relation to weight loss with at least five years of follow-up.
Search in Medline, PubMed, Embase, SciElo, Lilacs, Cochrane databases from 2001 (beginning of vertical gastrectomy) until 2018, using the following headings: "sleeve" or "sleeve gastrectomy" combined with "gastric bypass" or "Roux-en-Y gastric bypass", "weight loss" and "clinical trial". Criteria for inclusion of articles were patients aged between 18 and 65 years; clinical trial; comparison between the two techniques; minimum five-year follow-up; outcome with weight loss assessment.
The initial search identified 1940 articles, of which 185 publications were identified as clinical trials. One hundred and forty-one were excluded, 67 because they did not compare the two techniques, 57 not addressed weight loss and 17 were repeated articles. Thirty-four studies were retrieved for a more detailed analysis; 36 studies were excluded due to a follow-up of less than five years, and another compared the mini-gastric bypass. In total, seven studies were included in the systematic review, but there was no significant difference in three of them.
The gastric bypass had a greater weight loss than the vertical gastrectomy in all the evaluated studies.
减重手术目前是治疗肥胖症的金标准。两种最成熟的手术是Roux-en-Y胃旁路术和袖状胃切除术,关于哪种更好存在争议。
比较这两种技术在至少五年随访期内的减重效果。
检索2001年(垂直胃切除术开始)至2018年的Medline、PubMed、Embase、SciElo、Lilacs、Cochrane数据库,使用以下主题词:“袖状”或“袖状胃切除术”与“胃旁路术”或“Roux-en-Y胃旁路术”、“体重减轻”和“临床试验”。纳入文章的标准为年龄在18至65岁之间的患者;临床试验;两种技术之间的比较;至少五年的随访;有体重减轻评估的结果。
初步检索确定了1940篇文章,其中185篇被确定为临床试验。排除了141篇,67篇是因为未比较两种技术,57篇未涉及体重减轻,17篇是重复文章。检索到34项研究进行更详细的分析;由于随访时间少于五年又排除了36项研究,另有一项比较了迷你胃旁路术。系统评价共纳入七项研究,但其中三项没有显著差异。
在所有评估研究中,胃旁路术的减重效果优于垂直胃切除术。