Bregion Pedro Bicudo, Reis André Milani, Jucá Rafaela Hamada, de Oliveira-Filho Josélio Rodrigues, da Rocha Soares Giulia Almiron, Cazzo Everton, Ivano Victor Kenzo
State University of Campinas, Campinas, Brazil.
Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil.
Obes Surg. 2025 Mar;35(3):1146-1159. doi: 10.1007/s11695-025-07743-6. Epub 2025 Feb 18.
Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) contributes significantly to higher weight loss at 6 to 12 months when compared to Laparoscopic Sleeve Gastrectomy (LSG) in patients with severe obesity (SO-body mass index (BMI) ≥ 50 kg/m). However, there is still no consensus regarding the best procedure in terms of mortality and complication rates. We performed a systematic review and meta-analysis to compare the complication rates between these two surgical procedures.
PubMed, EMBASE, and Cochrane Central were searched for studies that compared LRYGB and LSG in SO patients. We pooled outcomes for mortality and complications, defined as bleeding, cardiovascular events, conversion to open procedure, and a composite endpoint of leak, abscess, fistulas, and reoperation. Length of stay and operative time were also pooled. A random-effects model was used, and statistical analyses were performed using R version 4.4.0.
A total of 156,767 patients from 28 observational studies were included, of whom 79,324 (50.6%) underwent LRYGB and 77,443 (49.4%) LSG. Length of stay (MD 0.45; 95% CI 0.42-0.48; P < 0.01) and operative time (MD 58.88; 95% CI 37.88-79.87; P < 0.01) were lower in the LSG group. Overall, there was no difference in mortality (OR 1.28; 95% CI 0.80-2.04; P = 0.311) and in complication rates (OR 1.22; 95% CI 0.85-1.76; P = 0.287). A subgroup analysis showed lower conversion to open procedure for patients who underwent LSG (OR 2.75; 95% CI 1.90-3.98; P < 0.001), and no difference was noted in bleeding (OR 0.98; 95% CI 0.47-2.07; P = 0.965), cardiovascular events (OR 0.99; 95% CI 0.43-2.29; P = 0.983), and a composite endpoint of leak, abscess, and fistulas (OR 0.82; 95% CI 0.67-1.01; P = 0.066).
Our meta-analysis suggests that there is no difference in mortality and complication rates between the two groups. However, length of stay and operative time were lower in SO patients who underwent LSG.
与腹腔镜袖状胃切除术（LSG）相比，腹腔镜Roux-en-Y胃旁路术（LRYGB）在重度肥胖患者（SO-体重指数（BMI）≥50kg/m²）6至12个月时能显著促进更多体重减轻。然而，在死亡率和并发症发生率方面，关于最佳手术方式仍未达成共识。我们进行了一项系统评价和荟萃分析，以比较这两种手术方式的并发症发生率。
检索PubMed、EMBASE和Cochrane Central，查找比较SO患者中LRYGB和LSG的研究。我们汇总了死亡率和并发症的结果，并发症定义为出血、心血管事件、转为开放手术以及包括渗漏、脓肿、瘘管和再次手术的复合终点。住院时间和手术时间也进行了汇总。使用随机效应模型，并使用R 4.4.0版本进行统计分析。
共纳入来自28项观察性研究的156,767例患者，其中79,324例（50.6%）接受了LRYGB，77,443例（49.4%）接受了LSG。LSG组的住院时间（MD 0.45；95%CI 0.42 - 0.4 August；P < 0.01）和手术时间（MD 58.88；95%CI 37.88 - 79.87；P < 0.01）较短。总体而言，死亡率（OR 1.28；95%CI 0.80 - 2.04；P = 0.311）和并发症发生率（OR 1.22；95%CI 0.85 - 1.76；P = 0.287）无差异。亚组分析显示，接受LSG的患者转为开放手术的比例较低（OR 2.75；95%CI 1.90 - 3.98；P < 0.001），在出血（OR 0.98；95%CI 0.47 - 2.07；P = 0.965）、心血管事件（OR 0.99；95%CI 0.43 - 2.29；P = 0.983）以及渗漏、脓肿和瘘管的复合终点（OR 0.82；95%CI 0.67 - 1.01；P = 0.066）方面无差异。
我们的荟萃分析表明，两组之间的死亡率和并发症发生率无差异。然而，接受LSG的SO患者的住院时间和手术时间较短。
