Banded Sleeve Gastrectomy More Effective Than Sleeve Gastrectomy for Obesity

bariatric surgery
Operation using laparoscopic equipment
Researchers compared banded sleeve gastrectomy with sleeve gastrectomy alone to determine differences in excess weight loss among patients with obesity.

Banded sleeve gastrectomy (BSG) is superior to sleeve gastrectomy (SG) in patients with obesity, according to a study in the American Journal of Surgery.

Researchers conducted a pairwise meta-analysis comparing the performance of BSG with SG in patients with obesity after performing a bibliographic search of major databases through October 2020. Eligible studies were relevant randomized-controlled trials (RCTs) or nonrandomized comparative series published in full text.

The primary outcome was the percentage of excess weight loss (%EWL), calculated as (initial weight – follow-up weight)/(initial weight – body weight at a BMI of 25 kg/m2 ) x 100, assessed at 3 years.

A total of 6 studies with 673 patients (312 treated with BSG and 361 with SG) were included in the analysis.

Both procedures had a sharp decrease in %EWL at 1 year, with no significant difference (standardized mean difference [SMD] 5.99, − 1.17 to 13.16) and moderate evidence of heterogeneity (I2=38%), according to analysis of 4 studies. The magnitude of the difference in %EWL between BSG and SG increased significantly from 2 years after the treatment. The SMD was 15.95 (13.31-18.58) at 2 years, 18.37 (13.31-23.42) at 3 years, 24.75 (22.38-27.12) at 4 years, and 29.85 (27.22-32.49) at 5 years (Table 2). The heterogeneity was mostly low or moderate.

In the comparison of BSG and SG for %EWL at 3 years, based on 4 studies of 521 patients, the SMD was 18.37 (13.31-23.42), indicating a clear benefit with BSG (P <.001), the researchers noted.

No difference was found regarding HbA1c at 3 years (SMD 0.40, − 0.64 to 1.43; I2=42%), based on 2 studies.

No significant correlations were observed regarding baseline mean age, proportion of male patients, and mean BMI with %EWL at 3 years, according to meta-regression analysis.

The pooled rate of overall complications was 2.6% (0%-5.1%) in patients who received BSG and 1.1% (0%-2.3%) in those who had SG, with no difference between the 2 groups (odds ratio [OR], 1.44, 0.55-3.76; I2=0%). No difference was found in major complications (pooled rate 1.3%, 0%-2.5% after BSG and 0.5%, 0%-1.3% after SG; OR 1.14, 0.52-1.87).

New onset of gastro-esophageal reflux disease was observed in 14.3% (0.3%-28.2%) of patients who had BSG and 14.6% (0.9%-28.4%) of those who had SG, with no difference between the 2 techniques (OR, 1.06, 0.56-2; I2=0%).

Among several study limitations, the number of included studies and treated patients was relatively low, and both RCTs and nonrandomized studies were included. In addition, some comparisons were impaired by moderate heterogeneity, and some relevant subgroup analyses could not be performed owing to lack of data.

“BSG is superior to standard SG in obese patients, due to its ability to significantly increase %EWL with no additional safety issues as compared to standard technique,” the researchers concluded.

Reference

Facciorusso A, Ramai D, Tartaglia N, Pavone G, Pacilli M, Ambrosi A. Banded versus non-banded sleeve gastrectomy in obese patients: a systematic review & meta-analysis. Am J Surg. Published online May 20, 2022. doi:10.1016/j.amjsurg.2022.05.015

This article originally appeared on Gastroenterology Advisor