Advertisement

Obesity Surgery

, Volume 29, Issue 1, pp 114–126 | Cite as

Outcomes After Metabolic Surgery in Asians—a Meta-analysis

  • Danson YeoEmail author
  • Charleen Yeo
  • Tze Yi Low
  • Saleem Ahmed
  • Sheena Phua
  • Aung Myint Oo
  • Jaideepraj Rao
  • Aaryan Koura
  • Kavita Venkataraman
  • Sanghvi Kaushal
Original Contributions
  • 156 Downloads

Abstract

Background

Obesity and type 2 diabetes mellitus (T2DM) are now increasingly epidemic in Asia. As obesity and T2DM have different disease patterns in Asians compared to Westerners, outcomes after metabolic surgery may differ. The aim of this meta-analysis was to gather the current available evidence on the outcomes after metabolic surgery in Asians.

Methods

A literature search was conducted in September 2017. Four outcome measures were examined: (1) % excess weight loss (EWL), (2) post-intervention body mass index (BMI), (3) T2DM resolution or improvement, and (4) hypertension resolution.

Results

Thirteen publications with a total of 1052 patients were analyzed, of which nine were randomized controlled trials, and four were case-matched studies. All the studies had a minimum follow-up duration of at least 1 year. % EWL was significantly higher in those who have undergone Roux-en-Y gastric bypass (RYGB) (SMD 0.53, 95% CI 0.12 to 0.94) versus sleeve gastrectomy (SG). T2DM resolution/improvement was favorable in those who have undergone RYGB (pooled OR 1.39, 95% CI 0.53 to 3.67) versus SG, although not statistically significant. Hypertension resolution was not significantly different between patients who have undergone SG versus RYGB (pooled OR 0.96, 95% CI 0.44 to 2.11).

Conclusion

RYGB results in better weight loss compared to SG in Asians, but the rate of T2DM resolution/improvement and improvement of hypertension appears to be similar. In Asian patients without symptoms of gastro-esophageal reflux disease in whom metabolic surgery is performed mainly for T2DM and metabolic syndrome, SG may be the surgery of choice.

Keywords

Metabolic surgery Bariatric surgery Roux-en-Y gastric bypass Sleeve Gastrectomy Asian Diabetes Hypertension %EWL BMI 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

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

Informed Consent Statement

Does not apply.

References

  1. 1.
    Chan JC, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301:2129–40.CrossRefGoogle Scholar
  2. 2.
    Yoon KH, Lee JH, Kim JW, et al. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006;368:1681–8.CrossRefGoogle Scholar
  3. 3.
    Lear SA, Humphries KH, Kohli S, et al. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86:353–9.CrossRefGoogle Scholar
  4. 4.
    Dickinson S, Colagiuri S, Faramus E, et al. Postprandial hyperglycemia and insulin sensitivity differ among lean young adults of different ethnicities. J Nutr. 2002;132:2574–9.CrossRefGoogle Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefGoogle Scholar
  6. 6.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641–51.CrossRefGoogle Scholar
  7. 7.
    Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective. Obes Surg. 2005;15:751–7.CrossRefGoogle Scholar
  8. 8.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.CrossRefGoogle Scholar
  9. 9.
    Garg H, Priyadarshini P, Aggarwal S, et al. Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study. World J Gastrointest Endosc. 2017;9:162–70.CrossRefGoogle Scholar
  10. 10.
    Ikramuddin S, Korner J, Lee WJ, et al. Durability of addition of Roux-en-Y gastric bypass to lifestyle intervention and medical management in achieving primary treatment goals for uncontrolled type 2 diabetes in mild to moderate obesity: a randomized control trial. Diabetes Care. 2016;39:1510–8.CrossRefGoogle Scholar
  11. 11.
    Tang Q, Sun Z, Zhang N, et al. Cost-effectiveness of bariatric surgery for type 2 diabetes mellitus: a randomized controlled trial in China. Medicine (Baltimore). 2016;95:e3522.CrossRefGoogle Scholar
  12. 12.
    Du X, Zhang SQ, Zhou HX, et al. Laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: a 1:1 matched cohort study in a Chinese population. Oncotarget. 2016;7:76308–15.Google Scholar
  13. 13.
    Huang CK, Tai CM, Chang PC, et al. Loop Duodenojejunal bypass with sleeve gastrectomy: comparative study with roux-en-Y gastric bypass in type 2 diabetic patients with a BMI <35 kg/m(2). First Year Results Obes Surg. 2016;26:2291–301.CrossRefGoogle Scholar
  14. 14.
    Yang J, Wang C, Cao G, et al. Long-term effects of laparoscopic sleeve gastrectomy versus roux-en-Y gastric bypass for the treatment of Chinese type 2 diabetes mellitus patients with body mass index 28-35 kg/m(2). BMC Surg. 2015;15:88.CrossRefGoogle Scholar
  15. 15.
    Hsin MC, Huang CK, Tai CM, et al. A case-matched study of the differences in bone mineral density 1 year after 3 different bariatric procedures. Surg Obes Relat Dis. 2015;11:181–5.CrossRefGoogle Scholar
  16. 16.
    Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg 2014: 24; 1617-1624Google Scholar
  17. 17.
    Liang Z, Wu Q, Chen B, et al. Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial. Diabetes Res Clin Pract. 2013;101:50–6.CrossRefGoogle Scholar
  18. 18.
    Praveen Raj P, Kumaravel R, Chandramaliteeswaran C, et al. Is laparoscopic duodenojejunal bypass with sleeve an effective alternative to Roux en Y gastric bypass in morbidly obese patients: preliminary results of a randomized trial. Obes Surg 2012: 22; 422–426Google Scholar
  19. 19.
    Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146:143–8.CrossRefGoogle Scholar
  20. 20.
    Lee WJ, Chong K, Lin YH, et al. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014;24:1552–62.CrossRefGoogle Scholar
  21. 21.
    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; 20–28Google Scholar
  22. 22.
    Zhang C, Yuan Y, Qiu C, et al. A meta-analysis of 2-year effect after surgery: laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus. Obes Surg. 2014;24:1528–35.CrossRefGoogle Scholar
  23. 23.
    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.CrossRefGoogle Scholar
  24. 24.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.CrossRefGoogle Scholar
  25. 25.
    Li JF, Lai DD, Lin ZH, et al. Comparison of the long-term results of Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis of randomized and nonrandomized trials. Surg Laparosc Endosc Percutan Tech. 2014;24:1–11.CrossRefGoogle Scholar
  26. 26.
    Zhang Y, Wang J, Sun X, et al. Laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass for morbid obesity and related comorbidities: a meta-analysis of 21 studies. Obes Surg. 2015;25:19–26.CrossRefGoogle Scholar
  27. 27.
    Li J, Lai D, Wu D. Laparoscopic Roux-en-Y Gastric bypass versus laparoscopic sleeve gastrectomy to treat morbid obesity-related comorbidities: a systematic review and meta-analysis. Obes Surg. 2016;26:429–42.CrossRefGoogle Scholar
  28. 28.
    Shoar S, Saber AA. Long-term and midterm outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass: a systematic review and meta-analysis of comparative studies. Surg Obes Relat Dis. 2017;13:170–80.CrossRefGoogle Scholar
  29. 29.
    Lee WJ, Aung L. Metabolic surgery for type 2 diabetes mellitus: experience from Asia. Diabetes Metab J. 2016;40:433–43.CrossRefGoogle Scholar
  30. 30.
    Mak KH, Chia KS, Kark JD, et al. Ethnic differences in acute myocardial infarction in Singapore. Eur Heart J. 2003;24:151–60.CrossRefGoogle Scholar
  31. 31.
    Kwon Y, Kim HJ, Lo Menzo E, et al. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2014;10:589–97.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Danson Yeo
    • 1
    Email author return OK on get
  • Charleen Yeo
    • 1
  • Tze Yi Low
    • 1
  • Saleem Ahmed
    • 1
  • Sheena Phua
    • 1
  • Aung Myint Oo
    • 1
  • Jaideepraj Rao
    • 1
  • Aaryan Koura
    • 1
  • Kavita Venkataraman
    • 2
  • Sanghvi Kaushal
    • 1
  1. 1.Upper Gastrointestinal Surgery Unit, Department of General SurgeryTan Tock Seng HospitalSingaporeSingapore
  2. 2.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore

Personalised recommendations