Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China.
Obes Surg. 2021 Sep;31(9):4142-4158. doi: 10.1007/s11695-021-05538-z. Epub 2021 Jul 5.
Bariatric surgery has been widely performed to treat morbid obesity. Our meta-analysis aims to provide an updated comparison between laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP). Medline, EMBASE, Scopus, and Cochrane Central were searched. Ongoing clinical trials were identified from the clinicaltrials.gov website. References of the chosen literatures were manually reviewed for additional relevant studies. As a result, a total of 18 studies involving 1329 patients were selected. We demonstrated a significant higher excess weight loss (%EWL) after LSG at the 1-, 3-, 6-, 12-, and 18-month follow-up time points. However, no significant difference was found at 36 months. Body Mass Index Loss (BMIL) was better after LSG than LGCP at 12 and 24 months. The difference in the improvement of comorbidities (i.e., T2-DM, hypertension, and sleep apnea) did not reach statistical significance. The complications (i.e., bleeding, stenosis, leak, and abdominal pain), operative time, and length of hospital stay were comparable. More patients undergoing LGCP experienced nausea and vomiting. We obtained some different and new results compared to the previously published meta-analysis. Our meta-analysis showed significantly higher %EWL at 24 months (Z=2.08, p=0.04), significantly higher BMIL at 36 months (Z=9.11, p <0.00001), and significantly higher costs (Z=2.87, p=0.004) in the LSG group. In addition, for the first time, complications (i.e., GERD, wound infection, port-site hernia, and mortality) and improvement of dyslipidemia were compared between the two techniques. According to our pooled data, no significant differences were found in any of the above aspects. In conclusion, LSG is superior to LGCP with regard to providing effective weight loss in the short- and mid-term. LSG has a lower rate of minor complications, but was less effective when considering cost. The two procedures are similar in terms of improvement of comorbidities, major complications, operative time, and length of stay.
减重手术已广泛用于治疗病态肥胖症。我们的荟萃分析旨在提供腹腔镜袖状胃切除术（LSG）和腹腔镜胃大弯折叠术（LGCP）之间的最新比较。检索了 Medline、EMBASE、Scopus 和 Cochrane Central。从 clinicaltrials.gov 网站确定了正在进行的临床试验。手动审查选定文献的参考文献，以寻找其他相关研究。结果，共选择了 18 项涉及 1329 名患者的研究。我们表明，LSG 在 1、3、6、12 和 18 个月的随访时间点的超重减轻百分比（%EWL）显著更高。然而，在 36 个月时没有发现显著差异。LSG 后 BMI 减轻（BMIL）优于 LGCP 在 12 个月和 24 个月。改善合并症（即 T2-DM、高血压和睡眠呼吸暂停）的差异没有达到统计学意义。并发症（即出血、狭窄、漏和腹痛）、手术时间和住院时间相当。更多接受 LGCP 的患者出现恶心和呕吐。与之前发表的荟萃分析相比，我们获得了一些不同的新结果。我们的荟萃分析显示，24 个月时%EWL 显著更高（Z=2.08，p=0.04），36 个月时 BMIL 显著更高（Z=9.11，p<0.00001），成本显著更高（Z=2.87，p=0.004）LSG 组。此外，这是第一次比较两种技术的并发症（即 GERD、伤口感染、端口疝和死亡率）和血脂异常改善情况。根据我们的汇总数据，在上述任何方面都没有发现显著差异。总之，LSG 在中短期提供有效的减肥效果优于 LGCP。LSG 的轻微并发症发生率较低，但考虑到成本，效果较差。两种手术在改善合并症、主要并发症、手术时间和住院时间方面相似。
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