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Bariatric surgery: a systematic review and network meta‐analysis of randomized trials
Author(s) -
Padwal R.,
Klarenbach S.,
Wiebe N.,
Birch D.,
Karmali S.,
Manns B.,
Hazel M.,
Sharma A. M.,
Tonelli M.
Publication year - 2011
Publication title -
obesity reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.845
H-Index - 162
eISSN - 1467-789X
pISSN - 1467-7881
DOI - 10.1111/j.1467-789x.2011.00866.x
Subject(s) - medicine , randomized controlled trial , sleeve gastrectomy , meta analysis , weight loss , gastric bypass , roux en y anastomosis , adverse effect , surgery , medline , clinical trial , gastrectomy , obesity , cancer , political science , law
Summary The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence‐based items potentially indicating risk of bias were assessed. Network meta‐analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30–48 y; mean BMI levels 42–58 kg/m 2 ) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: −11.4 kg/m 2 ], mini‐gastric bypass [−11.3 kg/m 2 ], biliopancreatic diversion [−11.2 kg/m 2 ], sleeve gastrectomy [−10.1 kg/m 2 ], Roux‐en‐Y gastric bypass [−9.0 kg/m 2 ], horizontal gastroplasty [−5.0 kg/m 2 ], vertical banded gastroplasty [−6.4 kg/m 2 ], and adjustable gastric banding [−2.4 kg/m 2 ]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux‐en‐Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.