Effectiveness of bariatric surgical procedures: A systematic review and network meta-analysis of randomized controlled trials
Open accessAbstract
BACKGROUND: Bariatric surgery has proved to be an effective strategy in treating obesity. However, randomized controlled trials (RCTs) of 3 most common bariatric surgery procedures, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric band (LAGB), reported inconsistent results. We performed a systematic review and network meta-analysis to synthesize evidence of effectiveness of the 3 common bariatric procedures from relevant RCTs. METHODS: The present study was a systematic review and network meta-analysis of RCTs. All RCTs must meet the following criteria to be included in the analysis: patients with body mass index (BMI) ≥30 kg/m, reported at least 1 outcome of interest, compared at least 2 of the 3 bariatric procedures, and had follow-ups of at least 1 year. Primary outcome was weight loss, expressed as differences in mean BMI reduction and percentage excess weight loss (%EWL) following 1 year after the surgery. Network meta-analysis was based on Bayesian framework with Markov Chain Monte Carlo simulation approach. RESULTS: Eleven RCTs that met the criteria were included in the review. Of 9 trials (n = 765), the differences in mean BMI reduction were -0.76 (95% CI: -3.1 to 1.6) for RYGB versus SG, -5.8 (95% CI: -9.2 to -2.4) for RYGB versus LAGB, and -5.0 (95% CI: -9.0 to -1.0) for SG versus LAGB. Eight RCTs (n = 656) reported percentage excess weight-loss (%EWL), the mean differences between RYGB and SG, RYGB and LAGB, and SG and LAGB were 3.8% (95% CI: -8.5% to 13.8%), -22.2% (95% CI: -34.7% to -6.5%), and -26.0% (95% CI: -40.6% to -6.4%), respectively. The meta-analysis indicated low heterogeneity between studies, and the node splitting analysis showed that the studies were consistent between direct and indirect comparisons (P > .05). CONCLUSION: The RYGB and SG yielded similar in weight-loss effect and both were superior to LAGB. Other factors such as complications and patient preference should be considered during surgical consultations.
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There was no difference in diabetes remission between RYGB and adjustable gastric banding (RR 1.96, 95% CI 0.47 to 8.33).
“There was no difference in diabetes remission (RR 1.96, 95% CI 0.47 to 8.33), although certainty of the evidence was low (Supplementary Table S17).”
There was no significant difference in diabetes remission between RYGB and sleeve gastrectomy (RR 0.89, 95% CI 0.73 to 1.06).
“There was no significant difference in EWL (WMD − 4%, 95% CI − 14% to 8%) or diabetes remission (RR 0.89, 95% CI 0.73 to 1.06), findings supported by moderate certainty of evidence.”
There was no significant difference in excess weight loss between RYGB and sleeve gastrectomy (WMD -4%, 95% CI -14% to 8%).
“There was no significant difference in EWL (WMD − 4%, 95% CI − 14% to 8%) or diabetes remission (RR 0.89, 95% CI 0.73 to 1.06), findings supported by moderate certainty of evidence.”
Sleeve gastrectomy was associated with 57% higher odds of diabetes remission compared with adjustable gastric banding (OR 0.43, 95% CI 0.19 to 0.98).
“Sleeve gastrectomy was associated with a weighted mean difference of 25% EWL (95% CI 6.4% to 41%) and 57% higher odds of diabetes remission (OR 0.43, 95% CI 0.19 to 0.98).”
Sleeve gastrectomy was associated with a weighted mean difference of 25% excess weight loss (95% CI 6.4% to 41%) compared with adjustable gastric banding.
“Sleeve gastrectomy was associated with a weighted mean difference of 25% EWL (95% CI 6.4% to 41%) and 57% higher odds of diabetes remission (OR 0.43, 95% CI 0.19 to 0.98).”
There was a marginal difference in major operative morbidity between RYGB and sleeve gastrectomy (OR 2.04, 95% CI 1.00 to 4.16).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
The weighted mean difference of excess weight loss was 22% (95% CI 6.5% to 34%) in favor of RYGB compared with adjustable gastric banding.
“The WMD of EWL was 22% (95% CI 6.5% to 34%) in favor of RYGB, which was associated with high certainty evidence.”
Remission of dyslipidemia and hypertension were in favor of sleeve gastrectomy compared with RYGB, but certainty of the evidence was very low.
“Remission of dyslipidemia and hypertension were in favor of sleeve gastrectomy, but certainty of the evidence was very low due to observational study design, risk of bias, inconsistency and indirectness (Supplementary Table S19).”
There were no differences in long-term minor complications between RYGB and sleeve gastrectomy (OR 0.64, 95% CI 0.28 to 1.47).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
There were no differences in long-term major complications between RYGB and sleeve gastrectomy (OR 0.64, 95% CI 0.21 to 1.96).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
There were no differences in minor perioperative complications between RYGB and sleeve gastrectomy (OR 1.43, 95% CI 0.60 to 3.23).
“There was marginal difference in major operative morbidity (OR 2.04, 95% CI 1.00 to 4.16), no differences in minor perioperative complications (OR 1.43, 95% CI 0.60 to 3.23), and long-term minor (OR 0.64, 95% CI 0.28 to 1.47) or major complications (OR 0.64, 95% CI 0.21 to 1.96), although the latter outcomes were associated with low or very low certainty of evidence.”
The present guidelines identified several gaps, particularly in the long-term reporting of outcomes.
“Despite the advances in the field, we have identified several gaps, particularly in the long-term reporting of outcomes [90, 91].”
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Bariatric Surgery Improves Renal Function: a Large Inner-City Population Outcome Study
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- Authors
- Kang, J. H., & Le, Q. A.
- Affiliations
- VA Loma Linda Healthcare System (US)
- Western University of Health Sciences (US)
- Corresponding author
- Le, Quang A.
- ORCID
- Le, Quang A.
- Venue
- Medicine
- Published
- 2017-11
- Volume
- 96
- Issue
- 46
- Pages
- e8632
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC5704829
- OpenAlex
- W2769146779
- Cited by
- 183
- References
- 40
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 12 · 2023: 26 · 2022: 27 · 2021: 28 · 2020: 26 · 2019: 30 · 2018: 14
- FWCI
- 4.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Medicine (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
- Keywords
- bariatric surgery, obesity, Roux-en-Y gastric bypass, sleeve gastrectomy, laparoscopic adjustable gastric band, weight loss, excess weight loss, body mass index reduction, surgical procedure comparison
- MeSH terms
- Humans, Obesity, Morbid, Outcome and Process Assessment, Health Care, Randomized Controlled Trials as Topic, Bariatric Surgery
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