Advanced Meta-Analysis and Bariatric Surgery

Abstract

Background: Obesity is one the most important public health concerns worldwide. Randomised clinical trials (RCT) have compared the various bariatric techniques and these have been incorporated in several meta-analyses and two network meta-analyses (NMA). Although two NMAs have been published, there has been a significant change in bariatric surgical practice and many new RCTs have been published since, including trials with long term outcome data and some that include medical therapy as a treatment arm. This indicates a need for an up-to-date NMA to answer questions regarding the risks and benefits of all the different surgical and medical treatments currently available for obesity. Aim: To compare the effectiveness of the various bariatric surgery techniques on the outcomes of weight change, resolution of obesity associated co-morbidities and reoperations in adults undergoing bariatric surgery. Methods: Article databases were searched systematically for all eligible RCTs. Primary outcomes were relative weight change (%EWL and %TWL) and absolute weight loss. Secondary outcomes included perioperative and long term complications, remission of type 2 diabetes (T2DM), remission of metabolic syndrome, presence of reflux and reoperation rate. Results: Fifty-seven RCTs were included, involving 5,999 patients and eight surgical procedures. Banded Roux-en-Y gastric bypass (RYGB), unbanded RYGB and biliopancreatic diversion with duodenal switch (BPD/DS) have the greatest weight loss (absolute and relative). Surgical procedures had greater remission of T2DM when compared to medical/non-surgical treatment. Conclusion: The results show banded RYGB, unbanded RYGB and BPD/DS have the greatest and most durable weight loss compared to medical/non-surgical treatment, adjustable gastric banded, sleeve gastrectomy, one anastomosis gastric bypass, horizontal gastroplasty and vertical gastroplasty. However, there is insufficient RCT data to rank the different bariatric options in terms of benefit and harm.