Huang Qiu-Shi, Huang Li-Bin, Zhao Rui, Yang Lie, Zhou Zong-Guang
Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Gastrointestinal Surgery, Chengdu Second People's Hospital, Chengdu, Sichuan Province, China.
Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Asian J Surg. 2024 Oct 10. doi: 10.1016/j.asjsur.2024.09.153.
Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric modalities. There is ongoing debate on the two modalities' long-term effects on weight loss and comorbidity resolution.PubMed, EMbase, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) comparing LRYGB versus LSG were searched by March 2024. Quality assessment was conducted by Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, following the procedures outlined in the Cochrane Collaborations tool (RoB 2.0 Assessment Form).In total, 13 datasets were included from 10 RCTs that involved 1106 individuals. Both the percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL) were greater in LRYGB compared to LSG at 3 years (MD: 13.04, 95%CI: 6.95-19.13; P < 0.0001) and 1 year (MD: 5.97, 95%CI: 5.23-6.71; P < 0.00001), respectively. When comparing LRYGB to LSG, the remission percentage for type 2 diabetes mellitus was greater at one (RR: 0.15, 95%CI: 0.03-0.27; P = 0.02) and 3 years (RR: 0.17, 95 % CI: 0.07-0.28; P = 0.001). Moreover, early (RR: 1.72, 95%CI: 1.19-2.46; P = 0.003) and late (RR: 1.40, 95%CI: 1.15-1.71; P = 0.001) adverse events were more common with LRYGB. Regarding remission from obstructive sleep apnea syndrome, dyslipidemia, and hypertension, no significant changes were seen. LRYGB and LSG are both viable bariatric surgery options for resolving long-term comorbidities. While the rate of adverse events is greater with LRYGB than LSG, the former may provide more long-term sustainable weight reduction.Additional research of a higher quality is necessary.
腹腔镜袖状胃切除术（LSG）和腹腔镜Roux-en-Y胃旁路术（LRYGB）是最常见的减肥手术方式。关于这两种手术方式对体重减轻和合并症缓解的长期影响，目前仍存在争议。截至2024年3月，我们在PubMed、EMbase和Cochrane对照试验中央注册库中检索了比较LRYGB与LSG的随机对照试验（RCT）。按照Cochrane协作工具（RoB 2.0评估表）中概述的程序，采用评估系统评价方法学质量（AMSTAR）指南进行质量评估。
总共纳入了来自10项RCT的13个数据集，涉及1106名个体。在3年时（MD：13.04，95%CI：6.95 - 19.13；P < 0.0001）和1年时（MD：5.97，95%CI：5.23 - 6.71；P < 0.00001），LRYGB组的超重减轻百分比（%EWL）和总体重减轻百分比（%TWL）均高于LSG组。与LSG相比，LRYGB组在1年时（RR：0.15，95%CI：0.03 - 0.27；P = 0.02）和3年时（RR：0.17，95%CI：0.07 - 0.28；P = 0.001）2型糖尿病的缓解率更高。此外，LRYGB组早期（RR：1.72，95%CI：1.19 - 2.46；P = 0.003）和晚期（RR：1.40，95%CI：1.15 - 1.71；P = 0.001）不良事件更常见。在阻塞性睡眠呼吸暂停综合征、血脂异常和高血压的缓解方面，未观察到显著变化。LRYGB和LSG都是解决长期合并症的可行减肥手术选择。虽然LRYGB的不良事件发生率高于LSG，但前者可能提供更长期可持续的体重减轻。需要进行更高质量的进一步研究。
