Obesity Surgery

, 19:1447 | Cite as

Bariatric Surgery for the Treatment of Morbid Obesity: A Meta-analysis of Weight Loss Outcomes for Laparoscopic Adjustable Gastric Banding and Laparoscopic Gastric Bypass

  • Jane Garb
  • Garry Welch
  • Sofija Zagarins
  • Jay Kuhn
  • John Romanelli
Review

Abstract

Bariatric surgery has emerged as an important tool in the fight against morbid obesity. However, reviewers have noted that there is a scarcity of long-term clinical surveillance data for bariatric surgery beyond 1-year follow-up and that a high percentage of patients are lost to follow-up, raising questions regarding the accuracy of current outcomes estimates. A meta-analysis of clinical reports providing bariatric surgery weight loss outcomes for morbidly obese patients was conducted over the period 2003–2007. Studies included were randomized controlled trials, nonrandomized controlled trials, and consecutive case series involving patients receiving either laparoscopic adjustable gastric banding (LAGB) or laparoscopic gastric bypass (LGB) surgery. Included studies involved n = 7,383 patients and were largely academic hospital-based (78.6%) and retrospective in design (71.4%). Weight loss outcome was defined by percent excess weight loss (%EWL). Composite estimates showed a significantly greater %EWL for LGB surgery (62.6%) compared to LAGB (49.4%). The superiority of LGB persisted at all three postsurgical time points examined (1, 2, and >3 years). Problems were identified regarding incomplete or suboptimal data reporting in many studies reviewed, and high patient attrition was evident at 2-year (49.8% LAGB, 75.2% LGB) and >3-year (82.6% LAGB, 89% LGB) end points. This meta-analysis confirms the superiority of LGB to LAGB in %EWL found in earlier studies. Although problems in study quality raised significant concerns regarding the validity of current weight loss estimates in this area, there was no evidence of publication bias.

Keywords

Laparoscopic gastric bypass LGB Laparoscopic adjustable gastric banding LAGB Bariatric surgery Outcomes %EWL Laparoscopic adjustable gastric banding LAGB laparoscopic gastric bypass LGB Weight loss 

References

  1. 1.
    Buchwald H. 2004 ASBS consensus conference statement. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis. 2005;1:371–81.CrossRefPubMedGoogle Scholar
  2. 2.
    Buchwald H. Obesity comorbidities. In: Buchwald H, Cowan GSM, Pories WJ, editors. Surgical management of obesity. Philadelphia: Saunders Elsevier; 2007.Google Scholar
  3. 3.
    Blankenship JD, Wolfe BM. Dietary management of obesity. In: Buchwald H, Cowan GSM, Pories WJ, editors. Surgical management of obesity. Philadelphia: Saunders Elsevier; 2007.Google Scholar
  4. 4.
    American Society for Metabolic and Bariatric Surgery (ASMBS) Fact sheet. http://www.asbs.org/Newsite07/media/fact-sheet1_bariatric-surgery.pdf. Accessed 10 April 2009
  5. 5.
    Bennett JMH, Mehta S, Rhodes M. Surgery for morbid obesity. Postgrad Med J. 2007;83:8–15.CrossRefPubMedGoogle Scholar
  6. 6.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  7. 7.
    Oria HE. Long term follow-up and evaluation of results in bariatric surgery. In: Buchwald H, Cowan GSM, Pories WJ, editors. Surgical management of obesity. Philadelphia: Saunders Elsevier; 2007.Google Scholar
  8. 8.
    Courcoulas AP, Flum DR. Filling in the gaps in bariatric surgery research. JAMA. 2005;294:1957–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Flanagan L. Practical training of the bariatric surgeon. In: Buchwald H, Cowan GSM, Pories WJ, editors. Surgical management of obesity. Philadelphia: Saunders Elsevier; 2007.Google Scholar
  10. 10.
    DerSimonian R, Laird N. Meta-analysis in clinical trails. Control Clin Trials. 1986;7:177–88.CrossRefPubMedGoogle Scholar
  11. 11.
    Cochran WG. Some methods for strengthening the common χ 2 tests. Biometrics. 1954;10:417–51.CrossRefGoogle Scholar
  12. 12.
    Whitehead A, Whitehead J. A general parametric approach to the meta-analysis of randomized clinical trials. Stat Med. 1991;10:1665–77.CrossRefPubMedGoogle Scholar
  13. 13.
    Cooper H, Hedges LV. In: Cooper H, Hedges LV, editors. The handbook of research synthesis. New York: Sage; 1994. p. 25.Google Scholar
  14. 14.
    Light RJ, Pillemer DB. Summing up: the science of reviewing research. Cambridge: Harvard University Press; 1984. p. 63–75.Google Scholar
  15. 15.
    Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):127–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Bowne WB, Julliard K, Castro AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: a prospective, comparative analysis. Arch Surg. 2006;141(7):683–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Buddeberg-Fischer B, Klaghofer R, Krug L, et al. Physical and psychosocial outcome in morbidly obese patients with and without bariatric surgery: a 4 1/2-year follow-up. Obes Surg. 2006;16(3):321–30.CrossRefPubMedGoogle Scholar
  18. 18.
    Dallal RM, Mattar SG, Lord JL, et al. Results of laparoscopic gastric bypass in patients with cirrhosis. Obes Surg. 2004;14(1):47–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Farkas DT, Vemulapalli P, Haider A, et al. Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI > or =60. Obes Surg. 2005;15(4):486–93.CrossRefPubMedGoogle Scholar
  20. 20.
    Fielding GA. Laparoscopic adjustable gastric banding for massive superobesity (>60 body mass index kg/m2). Surg Endosc. 2003;17(10):1541–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Fox SR, Fox KM, Srikanth MS, et al. The Lap-Band system in a North American population. Obes Surg. 2003;13(2):275–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Gould JC, Garren MJ, Starling JR. Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program. Obes Surg. 2004;14(5):618–25.CrossRefPubMedGoogle Scholar
  23. 23.
    Jan JC, Hong D, Pereira N, et al. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results. J Gastrointest Surg. 2005;9(1):30–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Jan JC, Hong D, Bardaro SJ, et al. Comparative study between laparoscopic adjustable gastric banding and laparoscopic gastric bypass: single-institution, 5-year experience in bariatric surgery. Surg Obes Relat Dis. 2007;3(1):42–50. discussion 50–1.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee WJ, Huang MT, Yu PJ, et al. Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison. Obes Surg. 2004;14(5):626–34.CrossRefPubMedGoogle Scholar
  26. 26.
    Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Moose D, Lourie D, Powell W, et al. Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting. Am Surg. 2003;69(11):930–2.PubMedGoogle Scholar
  28. 28.
    Mathus-Vliegen EM, de Weerd S, de Wit LT. Health-related quality-of-life in patients with morbid obesity after gastric banding for surgically induced weight loss. Surgery. 2004;135(5):489–97.CrossRefPubMedGoogle Scholar
  29. 29.
    Naef M, Naef U, Mouton WG, et al. Outcome and complications after laparoscopic Swedish adjustable gastric banding: 5-year results of a prospective clinical trial. Obes Surg. 2007;17(2):195–201.CrossRefPubMedGoogle Scholar
  30. 30.
    Olbers T, Fagevik-Olsén M, Maleckas A, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity. Br J Surg. 2005;92(5):557–62.CrossRefPubMedGoogle Scholar
  31. 31.
    Pajecki D, Dalcanalle L, Souza de Oliveira CP, et al. Follow-up of Roux-en-Y gastric bypass patients at 5 or more years postoperatively. Obes Surg. 2007;17(5):601–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Parikh MS, Fielding GA, Ren CJ. U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes. Surg Endosc. 2005;19(12):1631–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Parikh MS, Shen R, Weiner M, et al. Laparoscopic bariatric surgery in super-obese patients (BMI > 50) is safe and effective: a review of 332 patients. Obes Surg. 2005;15(6):858–63.CrossRefPubMedGoogle Scholar
  34. 34.
    Parikh M, Lo H, Chang C, et al. Comparison of outcomes after laparoscopic adjustable gastric banding in African–Americans and whites. Surg Obes Relat Dis. 2006;2(6):607–10.CrossRefPubMedGoogle Scholar
  35. 35.
    Perugini RA, Mason R, Czerniach DR, et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg. 2003;138(5):541–5. discussion 545–6.CrossRefPubMedGoogle Scholar
  36. 36.
    Ponce J, Paynter S, Fromm R. Laparoscopic adjustable gastric banding: 1, 014 consecutive cases. J Am Coll Surg. 2005;201(4):529–35.CrossRefPubMedGoogle Scholar
  37. 37.
    Puzziferri N, Austrheim-Smith IT, Wolfe BM, et al. Three-year follow-up of a prospective randomized trial comparing laparoscopic versus open gastric bypass. Ann Surg. 2006;243(2):181–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Ren CJ, Weiner M, Allen JW. Favorable early results of gastric banding for morbid obesity: the American experience. Surg Endosc. 2004;18(3):543–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Rubin M, Spivak H. Prospective study of 250 patients undergoing laparoscopic gastric banding using the two-step technique: a technique to prevent postoperative slippage. Surg Endosc. 2003;17(6):857–60.CrossRefPubMedGoogle Scholar
  40. 40.
    Shen R, Dugay G, Rajaram K, et al. Impact of patient follow-up on weight loss after bariatric surgery. Obes Surg. 2004;14(4):514–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Spivak H, Anwar F, Burton S, et al. The Lap-Band system in the United States: one surgeon’s experience with 271 patients. Surg Endosc. 2004;18(2):198–202.CrossRefPubMedGoogle Scholar
  42. 42.
    Steffen R, Biertho L, Ricklin T, et al. Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg. 2003;13(3):404–11.CrossRefPubMedGoogle Scholar
  43. 43.
    van Dielen FM, Soeters PB, de Brauw LM, et al. Laparoscopic adjustable gastric banding versus open vertical banded gastroplasty: a prospective randomized trial. Obes Surg. 2005;15(9):1292–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Belachew M. Laparoscopic adjustable gastric banding. In: Buchwald H, Cowan GSM, Pories WJ, editors. Surgical management of obesity. Philadelphia: Saunders Elsevier; 2007.Google Scholar
  45. 45.
    Longitudinal Assessment of Bariatric Surgery (LABS). National Institutes of Health, US Department of Health & Human Services. http://www.edc.pitt.edu/labs/Public/index.html. Accessed 15 April 2009.
  46. 46.
    Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med. 2001;134:657–62.PubMedGoogle Scholar
  47. 47.
    American College of Surgeons Bariatric Surgery Center Network (ACS BSCN). (2009) About ACS Accredited Bariatric Centers http://www.acsbscn.org/Public/AboutBSCN.aspx. Accessed on 15 April 2009

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Jane Garb
    • 1
  • Garry Welch
    • 2
  • Sofija Zagarins
    • 2
  • Jay Kuhn
    • 3
  • John Romanelli
    • 3
  1. 1.Biostatistics, Department of Academic AffairsBaystate Medical CenterSpringfieldUSA
  2. 2.Behavioral Medicine ResearchBaystate Medical CenterSpringfieldUSA
  3. 3.Weight Loss Surgery ProgramBaystate Medical CenterSpringfieldUSA

Personalised recommendations