Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston.
School of Human Movements and Nutrition Science, University of Queensland, Brisbane.
Surg Laparosc Endosc Percutan Tech. 2022 Aug 1;32(4):501-513. doi: 10.1097/SLE.0000000000001065.
There is a paucity of data that compares the relative complication profiles of laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) at 5 years.
The aim was to compare late complications of LVSG and LRYGB.
We updated our previous systematic review and meta-analysis of randomized controlled trials of primary LVSG and LRYGB procedures in adults, to review late (5 years) complication outcomes (PROSPERO 112054). Electronic databases were searched from January 2015 to July 2021 for publications meeting inclusion criteria. The Hartung-Knapp-Sidik-Jonkman random effects model was utilized to estimate weighted mean differences where meta-analysis was possible. Bias and certainty of evidence was assessed using the Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluations.
Four randomized controlled trials met the inclusion criteria (n=531; LVSG=272, LRYGB=259). No late treatment-related mortality was reported with either procedure. A significant reduction in surgical reoperations (odds ratio: 0.47, 95% confidence interval: 0.27-0.82, P =0.01) and endoscopic interventions (odds ratio: 0.29, 95% confidence interval: 0.12-0.71, P =0.02) were reported at 5 years post-LVSG relative to LRYGB. Reoperations were more frequently performed for reflux management in LVSG and for internal hernia repairs in LRYGB. Complications requiring medical management were common following both procedures. Limitations included few eligible studies for inclusion, and varying definitions of medically managed complications.
LRYGB is associated with a higher proportion of surgical and endoscopic interventions at 5 years compared with LVSG. More high-quality, long-term studies are required to further elucidate both surgical and nutritional long-term outcomes post these procedures.
比较腹腔镜垂直袖状胃切除术（LVSG）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）在 5 年后的相对并发症发生率的数据很少。
旨在比较 LVSG 和 LRYGB 的晚期并发症。
我们更新了之前对成人原发性 LVSG 和 LRYGB 手术的随机对照试验的系统评价和荟萃分析，以回顾晚期（5 年）并发症结局（PROSPERO 112054）。从 2015 年 1 月至 2021 年 7 月，电子数据库检索符合纳入标准的出版物。如果可以进行荟萃分析，则使用 Hartung-Knapp-Sidik-Jonkman 随机效应模型估计加权均数差。使用 Cochrane 偏倚风险工具和 Grading of Recommendations, Assessment, Development and Evaluations 评估偏倚和证据确定性。
四项随机对照试验符合纳入标准（n=531；LVSG=272，LRYGB=259）。两种手术均未报告晚期与治疗相关的死亡率。与 LRYGB 相比，LVSG 在 5 年后的手术再手术（比值比：0.47，95%置信区间：0.27-0.82，P=0.01）和内镜干预（比值比：0.29，95%置信区间：0.12-0.71，P=0.02）显著减少。LVSG 中再手术更频繁地用于反流管理，而 LRYGB 中用于内疝修复。两种手术都需要进行药物治疗的并发症很常见。局限性包括纳入的合格研究较少，以及对药物治疗并发症的定义不同。
与 LVSG 相比，LRYGB 在 5 年后与手术和内镜干预的比例更高。需要更多高质量、长期的研究来进一步阐明这些手术后的手术和营养长期结果。
