obese

Sleeve more effective than banding, more studies needed

Thursday, July 4, 2013 – 12:52

Owen Haskins – Editor in chief, Bariatric News

A meta-analysis has showed that laparoscopic sleeve gastrectomy (LSG) is a more effective procedure for morbid obesity than laparoscopic adjustable gastric banding (LAGB), with a greater effect on excess weight loss EWL and improvement of type 2 diabetes. The study authors from Nanjing Medical University, Nanjing, and Subei People’s Hospital of Jiangsu Province, Yangzhou, China, write that the meta-analysis confirms the need for larger, randomised, and long-term follow-up studies to compare the efficacy of LSG, LAGB, and laparoscopic Roux-en-Y gastric bypass.

The study, published in Obesity Surgery and available online, included 1,004 patients from 11 studies published between 2000 to 2012. The authors used the following inclusion criteria:

  • Studies including randomized controlled trials and non-randomized studies that compared LAGB with LSG;
  • Studies that provided information on at least one of the outcome measures; and
  • Studies published in English

The authors decided not to include case reports, articles that were not full text or non-comparative studies, and open operations (ie. those not performed by laparoscopic surgery).

Results

The results (Table 1) showed that LSG had a greater effect than LAGB on EWL at six and 12 months. For LAGB, the mean percentage EWL was 33.9 % after six months from six studies and 37.8 % after 12 months from four studies. In comparison, EWL was 50.6 % after six months and 51.8 % after 12 months from the same studies for LSG.

Author

Improve or resolve T2DM

EWL% (6ms)

EWL% (12ms)

LAGB

LSG

LAGB

LSG

LAGB

LSG

Simon   KH Wong et al

n/a

n/a

27±26

63      ±      33

31      ±      24

65      ±      32

B   Breznikar et al.

16/22

6/8

n/a

n/a

52.4 (−2.0–145.3)

57.9 (7.6–92.3)

Juan   J. Omana et al.

6/13

14/14

25.2±12

39.5±16

40.3±19

50.6±19

Joshua   B. Alley et al.

11/17

22/31

n/a

n/a

29.5±16.7

47.2±11.9

Kazunori   Kasama et al.

3/4

4/6

n/a

n/a

n/a

n/a

Paul   Brunault et al.

n/a

n/a

34.8±18.4

43.8±17.8

34.8±18.4

43.8±17.8

Susan   S. H. Gan

6/12

20/21

n/a

n/a

34.2

35.9

W.   K. Fenske et al.

n/a

n/a

n/a

n/a

45.0±2.4

47.8±4.5

S.   K. H. Wong

n/a

n/a

n/a

n/a

25.4±20.2

68.6±39.6

F.   B. Langer et al.

n/a

n/a

28.1±10.6

61.4±16.3

n/a

n/a

M.   A. Kueper et al.

n/a

n/a

39.1±19.1

33.0±10

n/a

n/a

H.   R. Hady et al.

4/8

18/39

48.98±6.58

62.71±21.17

n/a

n/a

Table 1: Main outcomes of the 12 studies included in the meta-analysis

After six and 12 months, the mean percentage EWL was higher for LSG than for LAGB by 33.0 and 27.0 %, respectively, indicating that (at these time points) LSG had a greater effect on weight loss than LAGB.

LSG was also superior to LAGB in treating type 2 diabetes. In five studies, 42 of 68 (61.8 %) type 2 diabetes patients experienced improvement of their diabetes after LAGB, whereas 66 of 80 (82.5 %) type 2 diabetes patients improved after LSG, an increase of 20.7 %.

They concluded that LSG was a more effective procedure than LAGB, with a pooled OR of 0.34 (95 % CI 0.16–0.73; Fig. 1) and pooled mean differences of −12.55 (95 % CI −15.66 to −9.43; Figure. 2) and −4.97 (95 % CI −7.58 to −8.36; Figure. 1), respectively.

Table 1: Forest plot of comparison: (1) LAGB vs LSG in terms of short-term results, outcome: (1.1) resolution of diabetes. Odds ratios are shown with 95 % CI

Table 2: Forest plot of comparison: (1) LAGB vs LSG in terms of short-term results, outcome: (1.1) resolution of diabetes. Odds ratios are shown with 95 % CI

The investigators created funnel plots to access the publication bias of the literature, they report that the shapes of the plots did not reveal “any evidence of obvious asymmetry.”

“Because LSG is a comparatively new procedure that has become popular in recent years, there is also concern about the long-term results; the follow-up periods in most reports are 6 or 12 months, and the studies analysed here provided relatively short-term findings,” the authors note. “Some studies that reported three-year results were not included in this meta-analysis because of insufficient data, but their numbers are low. There are few reports with a follow-up period of 5 years or more.”

 

 

 

 

 

 

 

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