Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials

doi:10.1016/j.soard.2013.05.007

Surgery for Obesity and Related Diseases

Volume 9, Issue 5, September–October 2013, Pages 816-829

https://doi.org/10.1016/j.soard.2013.05.007 Get rights and content

Abstract

Background

The evidence regarding the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) has been mostly based on the data derived from nonrandomized studies. The objective of this study was to evaluate the outcomes of LSG and to present an up-to-date review of the available evidence based on the recent publications of new randomized, controlled trials (RCTs).

Methods

PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched until November 2012 for RCTs on LSG.

Results

Fifteen RCTs, comprising a total of 1191 patients, of whom 795 had undergone LSG, were included. No patient required conversion to open surgery for LSG, laparoscopic gastric bypass (LGB), or laparoscopic adjustable gastric banding (LAGB) procedures. There were no deaths, and the complication rate was 12.1% (range 10%–13.2%) in the LSG group versus 20.9% (range 10%–26.4%) in the LGB group, and 0% in the LAGB group (only 1 RCT). The complications included leakage, bleeding, stricture, and reoperation that occurred with rates of .9%, 3.3%, 0%, and 2.1%, respectively, in the LSG group and rates of 0%, 5%, 0%, and 4%, respectively, in the LGB group. The average operating time in the LSG group was 106.5 minutes versus 132.3 minutes in the LGB group. The percentage of excess weight loss (%EWL) ranged from 49% to 81% in the LSG group, from 62.1% to 94.4% in the LGB group, and from 28.7% to 48% in the LAGB group, with a follow-up ranging from 6 months to 3 years. The type 2 diabetes mellitus (T2DM) remission rate ranged from 26.5% to 75% in the LSG group and from 42% to 93% in the LGB group.

Conclusions

LSG is a well-tolerated, feasible procedure with a relatively short operating time. Its effectiveness in terms of weight loss is confirmed for short-term follow-up (≤3 years). The role of LSG in the treatment of T2DM requires further investigation.

Section snippets

Methods

The methodology suggested by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement [19] was followed. This literature review was conducted using a systematic bibliographic search of the following online databases: MEDLINE, PubMed, Embase, and the Cochrane Register of Controlled Clinical Trials. The search was conducted until November 2012. An additional search was performed using “Google Scholar.” We searched the online database of 6 relevant high-impact

Surgical outcomes of LSG

Overall, the studies reporting at least 1 surgical outcome of interest on LSG, irrespective of the comparator procedures, were 14 (n = 795 patients) [14], [15], [16], [17], [18], [25], [26], [27], [28], [29], [30], [31], [32], [34]. Table 3 summarizes the data regarding the surgical outcomes of the LSG procedures.

Surgical outcomes for LSG compared with other bariatric procedures

The RCTs suitable for inclusion in this analysis comprised a total of 9 [14], [15], [16], [17], [27], [28], [29], [30], [31]. Six of these RCTs compared LSG with LGB [14], [15], [16], [17], [28], [31], 2 RCTs compared LSG with LAGB [27], [30], and 1 RCT compared LSG with SILSG [29].

Table 4 shows the summary of data on the surgical outcomes for the procedures that were compared with LSG.

Weight loss outcomes

After excluding the 2009 study by Peterli et al. [33], which presented an overlap of patients with the 2012 study [15] for these outcomes, a total of 7 RCTs reported one of the investigated weight loss outcomes [14], [15], [27], [28], [29], [30], [31]. The data on the weight loss outcomes for the LSG, LGB, and LAGB procedures in each of these studies are shown in Table 5.

Metabolic outcomes

Six of the included studies [14], [16], [28], [29], [31], [33] reported on data regarding the effect of LSG on T2DM in 97 patients with T2DM (53.6%) of the 181 randomly assigned patients in these trials (Table 6). From 5 of the included studies [14], [16], [29], [31], [33], we extrapolated the number of patients with diabetes who were able to discontinue their antidiabetic medications according to the criteria used in each study after LSG for an overall mean of 53.3% at a mean follow-up period

Discussion

To the best of our knowledge, this is the first systematic review to analyze surgical, metabolic, and weight loss outcomes from only RCTs on LSG. On the basis of observational evidence, LSG was recently ranked between LAGB and LGB in terms of morbidity and effectiveness [6], [7], [8].

From the analysis of all RCTs on LSG published in the literature (total of 1191 patients) to date and irrespective of bariatric procedures compared with LSG in these studies, we found an overall conversion to open

Conclusions

Considering the limitations of our study, we conclude that the evidence derived from the RCTs available in the literature suggests that LSG is safe and highly feasible, with a relatively short operating time and the capability of ensuring an effective weight loss in a short-term follow-up. LSG has a lower overall postoperative morbidity and a lower reoperation rate than does LGB; LSG can ensure a comparable weight loss in a short-term period (<3 yr). The incidence of major complications was

References (55)

R.J. Rosenthal et al.
International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of>12,000 cases
Surg Obes Relat Dis
(2012)
E.J. DeMaria et al.
Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database
Surg Obes Relat Dis
(2010)
T.D. Jackson et al.
Morbidity and effectiveness of laparoscopic sleeve gastrectomy, adjustable gastric band, and gastric bypass for morbid obesity
Adv Surg
(2012)
R.S. Gill et al.
Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review
Surg Obes Relat Dis
(2010)
S.A. Brethauer et al.
Systematic review of sleeve gastrectomy as staging and primary bariatric procedure
Surg Obes Relat Dis
(2009)
J.M. Ramon et al.
Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial
J Gastrointest Surg
(2012)
T.C. Chalmers et al.
A method for assessing the quality of a randomized control trial
Control Clin Trials
(1981)
A.R. Jadad et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996)
M.R. Siddiqui et al.
Elective laparoscopic sigmoid resection for diverticular disease has fewer complications than conventional surgery: a meta-analysis
Am J Surg
(2010)
W.J. Lee et al.
Changes in postprandial gut hormones after metabolic surgery: a comparison of gastric bypass and sleeve gastrectomy
Surg Obes Relat Dis
(2011)

B. Woelnerhanssen et al.

Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy--a prospective randomized trial

Surg Obes Relat Dis

(2011)

X. Nogues et al.

[Bone mass loss after sleeve gastrectomy: a prospective comparative study with gastric bypass]

Cir Esp

(2010)

A.I. Sarela et al.

Long-term follow-up after laparoscopic sleeve gastrectomy: 8–9-year results

Surg Obes Relat Dis

(2012)

J.B. Dixon et al.

Bariatric surgery for type 2 diabetes

Lancet

(2012)

S.M. Chikunguwo et al.

Surg Endosc

(2012)

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Original articleLaparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Surgical outcomes of LSG

Surgical outcomes for LSG compared with other bariatric procedures

Weight loss outcomes

Metabolic outcomes

Discussion

Conclusions

Surg Obes Relat Dis

Surg Obes Relat Dis

Adv Surg

Surg Obes Relat Dis

Surg Obes Relat Dis

J Gastrointest Surg

Control Clin Trials

Control Clin Trials

Am J Surg

Surg Obes Relat Dis

Surg Obes Relat Dis

Cir Esp

Surg Obes Relat Dis

Lancet

Surg Obes Relat Dis

Updated position statement on sleeve gastrectomy as a bariatric procedure

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Original article
Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials