Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Laparoscopic vertical sleeve gastrectomy (LVSG) has overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most frequently performed bariatric surgical procedure. To date little has been reported on the long-term outcomes of the LVSG procedure comparative to the traditionally favoured LRYGB. We undertook a systematic review and meta-analysis to review the five year outcomes of comparing LVSG and LRYGB.We undertook a systematic review and meta-analysis to compare five year weight loss outcomes of randomized controlled trials (RCTs) comparing LVSG to LRYGB.Methods: Searches of electronic databases (Pubmed, EMBASE, CINAHL, Cochrane) were undertaken for RCTs describing weight loss outcomes in adults at five years postoperatively.Where sufficient data was available to undertake meta-analysis, the Hartung-Knapp-Sidik-Jonkman (HKSJ) estimation method for random effects model was utilised. The review was registered with PROSPERO and reported following in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results:Five studies met the inclusion criteria totalling 1028 patients (LVSG=520, LRYGB=508). Moderate but comparable levels of bias were observed within studies.Statistically significant BMI loss ranged from -11.37kg/m 2 (range -6.3 to -15.7 kg/m 2 ) in the LVSG group and -12.6 kg/m 2 (range -9.5 to -15.4 kg/m 2 ) for LRYGB at five years (p<0.001).Systematic review suggested that LRYGB produced a greater weight loss expressed as percent excess weight and percent excess BMI loss than LVSG: this was not corroborated in the meta-analysis. Conclusions:Five year weight loss outcomes suggest both LRYGB and LVSG are effective in achieving significant weight loss at five years postoperatively, however differences in reporting parameters limit the ability to reliably compare the outcomes using statistical methods. Furthermore, results may be impacted by large dropout rates and per protocol 4 analysis of the two largest included studies. Further long-term studies are required to contradict or validate the results of this meta-analysis.

Results and Conclusions of “Five-Year Weight Loss Outcomes in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Systematic Review and Meta-analysis of Randomized Controlled Trials” Unchanged by Omission of Retracted Ruiz-Tovar et al Article

“…In conclusion the results and conclusions presented in our published paper [2] remain largely unchanged by our reanalysis omitting of the Ruiz-Tovar et al study. Its absence, however, adds to the limitations outlined in our paper and further highlights the critical need for more long-term studies comparing these two procedures.…”

“…We reanalysed all relevant data omitting the Ruiz-Tovar et al study [3], using the methods outlined in our published article [2].…”

Variables Associated with Short-Term Weight Loss in a Cohort of Patients with Morbid Obesity According to Age and Three Types of Bariatric Surgery

“…Most of the studies demonstrated and maintained weight loss through follow-up at five years and even for longer intervals (up to 11 years) [43]. However, a slow weight gain between the second and third years of postsurgery follow-up is found, increasing up to 5 years postsurgery [45]. Although, based on previous reviews, our results could be generalized to long-term weight loss, we cannot confirm this hypothesis without data.…”

Late (≥5 y) Complications of Laparoscopic Vertical Sleeve Gastrectomy (LVSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB): A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…3 The laparoscopic vertical sleeve gastrectomy (LVSG) is now the most frequently performed bariatric surgical procedure in the United States, having overtaken the laparoscopic Roux-en-Y gastric bypass (LRYGB) which has historically been considered the gold standard for bariatric surgical outcomes. 2 While these procedures are effective at facilitating long-term weight loss, 4 the long-term complication profile of these 2 procedures are still being elucidated, particularly in respect to their relative benefits and risks.…”

“…This systematic review and meta-analysis has been undertaken to compare the ≥ 5 years late complications reported between LRYGB with LVSG procedures in randomized controlled trials (RCTs): It represents a continuation of our previous works on this topic. [4][5][6]…”