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Obesity Surgery

, Volume 29, Issue 10, pp 3252–3263 | Cite as

Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding

  • Chang Wu
  • Fu-gang Wang
  • Wen-Mao Yan
  • Ming Yan
  • Mao-min SongEmail author
Original Contributions

Abstract

Background

Over recent decades, laparoscopic adjustable gastric banding (LAGB) has been among the most common bariatric surgeries. Nowadays, many patients require revision surgery due to insufficient weight loss and band-related complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the two most common revision surgeries for failed LAGB, but the conclusions about their efficacy and safety have been inconsistent. This meta-analysis aimed to review the clinical outcomes of SG and RYGB after failed LAGB.

Methods

In accordance with the PRISMA guidelines, the PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for articles that had studied the efficacy and safety of SG and RYGB. The most appropriate effects model was chosen based on the heterogeneity of the articles included in this meta-analysis. Statistical analysis was conducted using Stata 14.0.

Results

Of 586 articles that were retrieved, 16 articles which examined 2141 SG and 2990 RYGB patients met the inclusion criteria. The patients in RYGB groups showed increased percent excess weight loss (%EWL) at 12 and 24 months after revision surgery but no statistically significant change was found about %EWL after 3, 6, or 36 months. In addition, RYGB was associated with a higher rate of complications, interventions, and readmission in addition to being of more operative time.

Conclusions

This review suggested that RYGB was more effective at demonstrating weight loss after 12 and 24 months, but comparisons of the long-term efficacy of RYGB with that of SG remain inconclusive. In addition, RYGB was accompanied by a greater number of post-operative complications, interventions, and readmissions. Thus, surgeons should consider the overall status of the patients and their comorbidities as crucial factors when selecting a form of revision surgery. Additional high-quality randomized controlled studies are required to further compare the efficacy and safety of these treatments with longer follow-up times.

Keywords

Failed adjustable gastric banding Sleeve gastrectomy Gastric bypass Revision surgery 

Notes

Acknowledgments

Our team thanks Shi-cheng, Rixing-bai, Meng-zhao, and Hongyi-zhang of Tiantan Hospital for their insightful comments and suggestions. Capital Medical University is also acknowledged.

Compliance with Ethical Standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11695_2019_3988_Fig7_ESM.png (373 kb)
Figure S1

The forest plot showed the WMD (95% CI) of hospital stay and operative time for RYGB and SG groups as revision surgery after failed LAGB with random-effects model (PNG 372 kb)

11695_2019_3988_MOESM1_ESM.tif (4.4 mb)
High resolution image (TIF 4473 kb)
11695_2019_3988_Fig8_ESM.png (68 kb)
Figure S2

Egger’s test for identifying publication bias for %EWL at 12 months (PNG 67 kb)

11695_2019_3988_MOESM2_ESM.tif (2.5 mb)
High resolution image (TIF 2560 kb)
11695_2019_3988_Fig9_ESM.png (90 kb)
Figure S3

Begg’s test for identifying publication bias for %EWL at 12 months. (PNG 89 kb)

11695_2019_3988_MOESM3_ESM.tif (2.7 mb)
High resolution image (TIF 2806 kb)
11695_2019_3988_Fig10_ESM.png (112 kb)
Figure S4

Funnel plots for identifying publication bias for %EWL at 12 months (PNG 112 kb)

11695_2019_3988_MOESM4_ESM.tif (470 kb)
High resolution image (TIF 470 kb)
11695_2019_3988_MOESM5_ESM.doc (60 kb)
Table S1 PRISMA checklist (DOC 59 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General Surgery, Tiantan HospitalCapital Medical UniversityBeijingChina

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