Ponce de Leon-Ballesteros Guillermo, Romero-Velez Gustavo, Martinez-Portilla Raigam Jafet, Pereira Xavier, Roy-Garcia Ivonne, Fobi Mathias A L, Herrera Miguel F
Department of Surgery, Hospital Civil de Morelia Miguel Silva, Morelia, Michoacan, Mexico.
Department of Surgery, Montefiore Medical Center, Bronx, NY, USA.
Obes Surg. 2022 Jul;32(7):1-12. doi: 10.1007/s11695-022-06043-7. Epub 2022 Apr 22.
Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. It accounts for more than 50% of primary bariatric surgeries performed each year. Recent long-term data has shown an alarming trend of weight recidivism. Some authors have proposed the concurrent use of a non-adjustable gastric band to decrease long-term sleeve failure.
To compare the outcomes (weight loss) and safety (rate of complication and presence of upper GI symptoms) between SG and BSG.
A systematic search with no language or time restrictions was performed to identify relevant observational studies and randomized controlled trials (RCT) evaluating people with morbid obesity undergoing SG or SGB for weight loss. An inverse-of-the-variance meta-analysis was performed by random effects model. Heterogeneity was assessed using Cochrane X and I analysis.
A total of 7 observational studies and 3 RCT were included in the final analysis. There were 911 participants pooled from observational studies and 194 from RCT. BSG showed a significant higher excess of weight loss (% EWL). The difference among groups was clinically relevant after the third year where the weighted mean difference (SMD) was 16.8 (CI 95% 12.45, 21.15, p < 0.0001), while at 5 years, a SMD of 25.59 (16.31, 34.87, p < 0.0001) was noticed. No differences related to overall complications were noticed. Upper GI symptoms were up to three times more frequent in the BSG group (OR 3.26. CI 95% 1.96, 5.42, p < 0.0001).
According to the results, BSG is superior to SG in weight loss at 5 years but is associated with a higher incidence of upper GI symptoms. However, these conclusions are based mainly on data obtained from observational studies. Further RCT are needed to evaluate the effect and safety of BSG.
袖状胃切除术（SG）是全球最常见的减肥手术。它占每年主要减肥手术的50%以上。最近的长期数据显示出体重复发的惊人趋势。一些作者提议同时使用不可调节胃束带来降低袖状胃切除术的长期失败率。
比较袖状胃切除术（SG）和袖状胃加胃束带术（BSG）的治疗效果（体重减轻情况）和安全性（并发症发生率及上消化道症状情况）。
进行无语言或时间限制的系统检索，以识别评估病态肥胖患者接受SG或SGB减肥治疗的相关观察性研究和随机对照试验（RCT）。采用随机效应模型进行方差倒数元分析。使用Cochrane X和I分析评估异质性。
最终分析共纳入7项观察性研究和3项RCT。观察性研究汇总了911名参与者，RCT汇总了194名参与者。BSG显示出显著更高的超重减轻百分比（%EWL）。在第三年之后，组间差异具有临床相关性，加权平均差（SMD）为16.8（95%CI 12.45，21.15，p<0.0001），而在5年时，SMD为25.59（16.31，34.87，p<0.0001）。未发现与总体并发症相关的差异。BSG组上消化道症状的发生频率高达三倍（OR 3.26，95%CI 1.96，5.42，p<0.0001）。
根据结果，BSG在5年时的减肥效果优于SG，但与上消化道症状的较高发生率相关。然而，这些结论主要基于从观察性研究中获得的数据。需要进一步的RCT来评估BSG的效果和安全性。
