Comparative analysis for the effect of Roux-en-Y gastric bypass vs sleeve gastrectomy in patients with morbid obesity: Evidence from 11 randomized clinical trials (meta-analysis)

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) are the most common procedures performed during bariatric surgery and both of them have been demonstrated having significant efficacy for morbid obesity. However, the comparative analysis of the effect of them has not been well studied. Thus, this comparative analysis was conducted to determine whether LRYGB and LSG are equivalent for mid- and long-term weight loss, resolution of comorbidities and adverse events (AEs). METHODS: We searched the Cochrane Library, PubMed, Embase and Web of Science databases up to January 1, 2019 for studies that investigated LRYGB and LSG with respect to weight loss outcomes, resolution of comorbidities and AEs. Standardised mean differences (SMDs) and risk ratios (RR) with 95% confidence intervals (CIs) were calculated to compare the outcomes of the groups. Two reviewers assessed the quality of the trials and extracted the data independently. All statistical analyses were performed using the standard statistical procedures in Review Manager 5.2. RESULTS: We included 11 studies (N = 1,328 participants) in this meta-analysis. Our results showed no significant difference in excess weight loss between LRYGB and LSG, with a pooled SMD of -0.16 (95% CI: -0.52-0.19; P = 0.36). Further, the pooled results showed no significant difference in midterm and long-term weight loss between the comparative groups. Similarly, no significant difference was found in T2DM resolution. The pooled results indicate that patients receiving LSG experienced fewer postoperative complications and reoperation rate, with pooled RRs of 1.66 (95% CI: 1.33-2.07; P < 0.00001) and 1.73 (95% CI: 1.14-2.62; P = 0.01). LRYGB may be superior to LSG in dyslipidemia, hypertension and gastroesophageal reflux disease (GERD) remission. CONCLUSIONS: The present meta-analysis indicated that both LRYGB and LSG are equivalent for excess weight loss and T2DM resolution. However, patients receiving LSG experienced fewer postoperative complications and reoperation rate than those who underwent LRYGB. LRYGB may be superior in dyslipidemia, hypertension and gastroesophageal reflux disease (GERD) remission.