Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA.
Am J Surg. 2022 Oct;224(4):1156-1161. doi: 10.1016/j.amjsurg.2022.05.015. Epub 2022 May 20.
BACKGROUND & AIMS: Weight regain represents an important issue after sleeve gastrectomy (SG), hence banded sleeve gastrectomy (BSG) was proposed. Aim of this meta-analysis was to compare the performance ofBSG versus SG in obese patients.
We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized-controlled trials (recruiting673 patients). The primary outcome was % excess weight loss (%EWL); secondary outcomes included % total weight loss (%TWL), HbA1c improvement, overall complication and major complication rate, gastro-esophageal reflux disease (GERD)occurrence. We performed pairwise meta-analysis through a random effects model and expressed data as standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI).
A sharp decline in %EWL at 1 year was observed with both treatments with no significant difference (SMD 5.99, -1.17 to 13.16), whereas a clear benefit with BSG over SG was observed over time (SMD 15.95, 13.31 to 18.58 at 2 years; 18.37, 13.31 to 23.42 at 3 years; 24.75, 22.38 to 27.12 at 4 years; 29.85, 27.22 to 32.49 at 5 years). Meta-regression did not find any significant correlations between age, sex, and baseline BMI with %EWL. Similarly, no difference in terms of %TWL was observed at 1 year (SMD 1, -3.31 to 5.30), whereas the magnitude of the benefit with BSG increased significantly from the second year onwards (SMD 5.99, 3.7 to 8.27 at 2 year, 6.86, 5.13 to 8.59 at 3 year, and 9.36, 7.07 to 11.65 at 5 year). No difference in terms of HbA1c improvement was observed (SMD 0.40, -0.64 to 1.43). No difference in overall complication (OR 1.44, 0.55-3.76), major complications (OR 1.14, 0.52-1.87), and incidence of GERD was observed (OR 1.06, 0.56-2).
BSG is superior to SG in obese patients, due to its ability to significantly increase %EWL with no additional safety issues.
体重反弹是袖状胃切除术（SG）后的一个重要问题，因此提出了带囊胃袖状切除术（BSG）。本荟萃分析的目的是比较 BSG 与 SG 在肥胖患者中的疗效。
我们通过 PubMed/Medline 和 Embase 数据库检索至 2020 年 10 月，共纳入 6 项研究，其中 2 项为随机对照试验（共纳入 673 例患者）。主要结局为体重减轻百分比（%EWL）；次要结局包括总体重减轻百分比（%TWL）、糖化血红蛋白（HbA1c）改善、总体并发症和主要并发症发生率、胃食管反流病（GERD）发生情况。我们采用随机效应模型进行了成对荟萃分析，并通过标准化均数差（SMD）或比值比（OR）和 95%置信区间（CI）表示数据。
两种治疗方法在术后 1 年时 EWL 均明显下降，但无显著差异（SMD 5.99，-1.17 至 13.16），而随着时间的推移，BSG 明显优于 SG（SMD 15.95，13.31 至 18.58 岁；SMD 18.37，13.31 至 23.42 岁；SMD 24.75，12.31 至 27.12 岁；SMD 29.85，27.22 至 32.49 岁）。元回归分析未发现年龄、性别和基线 BMI 与 EWL 之间存在任何显著相关性。同样，在术后 1 年时，%TWL 无差异（SMD 1，-3.31 至 5.30），而 BSG 的获益幅度从第二年开始显著增加（SMD 5.99，3.7 至 8.27 岁；SMD 6.86，5.13 至 8.59 岁；SMD 9.36，7.07 至 11.65 岁）。HbA1c 改善无差异（SMD 0.40，-0.64 至 1.43）。总体并发症（OR 1.44，0.55-3.76）、主要并发症（OR 1.14，0.52-1.87）和 GERD 发生率（OR 1.06，0.56-2）无差异。
BSG 在肥胖患者中的疗效优于 SG，因为它能够显著增加 EWL，且无额外的安全性问题。
