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Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus: a Systematic Review and Network Meta-Analysis

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Abstract

Introduction

The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively.

Methods

We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM).

Results

Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = − 0.2% [− 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3–5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB.

Conclusions

RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.

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Author notes

  1. Chan Hyuk Park and Seung-Joo Nam contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea

    Chan Hyuk Park

  2. Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea

    Seung-Joo Nam

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea

    Hyuk Soon Choi

  4. Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea

    Kyoung Oh Kim

  5. Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Do Hoon Kim

  6. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea

    Jung-Wook Kim

  7. Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Won Sohn

  8. Division of Gastroenterology, Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro Seongdong-gu, Seoul, Postal code 04763, South Korea

    Jai Hoon Yoon & Hang Lak Lee

  9. Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Sung Hoon Jung

  10. Division of Gastroenterology, Department of Internal Medicine, Seoul Chuk Hospital, Seoul, South Korea

    Yil Sik Hyun

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  1. Chan Hyuk Park
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Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity

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Correspondence to Hang Lak Lee.

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Table S1

Baseline characteristics of the included studies (DOCX 21 kb)

Table S2

Percentage of excess weight loss according to the assessment timing (DOCX 22 kb)

Table S3

Diabetes remission according to the assessment timing (DOCX 18 kb)

Table S4

Surgical adverse event in the included studies (DOCX 20 kb)

Fig. S1

(PNG 384 KB)

High resolution image (TIF 751 kb)

Appendix 1. Detailed search strategy

Appendix 1. Detailed search strategy

MEDLINE (Pubmed)

((bariatric[TW] OR (metabolic surgery[TW]) OR (weight loss surgery[TW]) OR Roux-en-Y[TW] OR (restrictive bypass[TW]) OR (gastric bypass[TW]) OR (gastrojejunal bypass[TW]) OR (gastro-jejunal bypass[TW]) OR (gastroileal bypass[TW]) OR (gastro-ileal bypass[TW]) OR (duodenojejunal bypass[TW]) OR (duodeno-jejunal bypass[TW]) OR (duodenoileal bypass[TW]) OR (duodeno-ileal bypass[TW]) OR (sleeve gastrectomy[TW]) OR (gastric band*[TW]) OR (intragastric band*[TW]) OR (gastroplast*[TW]) OR (gastric balloon*[TW]) OR (vertical band*[TW]) OR (lapband*[TW]) OR (lap-band*[TW]) OR (adjustable band*[TW]) OR (gastric belt*[TW]) OR (gastric bubble[TW]) OR (gastric partition[TW]) OR (stomach stapling[TW]) OR (biliopancreatic diversion[TW]) OR (duodenal switch[TW])) OR ((obesity[Mesh] OR obesity[TW] OR obese[TW] OR overweight[Mesh] OR overweight[TW]) AND (surgery[Mesh] OR surgery[TW]))) AND (random*[TW]) AND (“1990/01/01”[Date - Publication]: “2018/02/27”[Date - Publication])

EMBASE (Ovid)

((bariatric or ‘metabolic surgery’ or ‘weight loss surgery’ or Roux-en-Y or ‘restrictive bypass’ or ‘gastric bypass’ or ‘gastrojejunal bypass’ or ‘gastro-jejunal bypass’ or ‘gastroileal bypass’ or ‘gastro-ileal bypass’ or ‘duodenojejunal bypass’ or ‘duodeno-jejunal bypass’ or ‘duodenoileal bypass’ or ‘duodeno-ileal bypass’ or ‘sleeve gastrectomy’ or ‘gastric band*’ or ‘intragastric band*’ or ‘gastroplast*’ or ‘gastric balloon*’ or ‘vertical band*’ or ‘lapband*’ or ‘lap-band*’ or ‘adjustable band*’ or ‘gastric belt*’ or ‘gastric bubble’ or ‘gastric partition’ or ‘stomach stapling’ or ‘biliopancreatic diversion’ or ‘duodenal switch’ or ((obesity or obese or overweight) and surgery)) and random*).ab,ti.

Cochrane library

bariatric or ‘metabolic surgery’ or ‘weight loss surgery’ or Roux-en-Y or ‘restrictive bypass’ or ‘gastric bypass’ or ‘gastrojejunal bypass’ or ‘gastro-jejunal bypass’ or ‘gastroileal bypass’ or ‘gastro-ileal bypass’ or ‘duodenojejunal bypass’ or ‘duodeno-jejunal bypass’ or ‘duodenoileal bypass’ or ‘duodeno-ileal bypass’ or ‘sleeve gastrectomy’ or ‘gastric band*’ or ‘intragastric band*’ or ‘gastroplast*’ or ‘gastric balloon*’ or ‘vertical band*’ or ‘lapband*’ or ‘lap-band*’ or ‘adjustable band*’ or ‘gastric belt*’ or ‘gastric bubble’ or ‘gastric partition’ or ‘stomach stapling’ or ‘biliopancreatic diversion’ or ‘duodenal switch’

  1. 1.

    obesity or obese or overweight

  2. 2.

    korea*

  3. 3.

    #2 and #3

  4. 4.

    #1 or #4

  5. 5.

    random*

  6. 6.

    #5 and #6 (Limit to trials published from 1990 to 2018)

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Park, C.H., Nam, SJ., Choi, H.S. et al. Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus: a Systematic Review and Network Meta-Analysis. OBES SURG 29, 2180–2190 (2019). https://doi.org/10.1007/s11695-019-03831-6

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