Bariatric Surgical Procedures for Obese and Morbidly Obese Patients: A Review of Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet]

Excerpt

Bariatric surgery has been proven to be more effective than other measures such as medications and lifestyle interventions for weight loss. There are a number of bariatric surgical procedures currently available, and the most commonly performed procedures are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB). RYGB involves restricting the size of the stomach to create a much smaller gastric pouch, and attaching the pouch to the mid-jejunum, resulting in malabsorption of food. SG involves removing the greater fundus and curvature of the stomach, creating a much smaller tube-like stomach, thereby restricting food intake. LAGB uses a band that is encircled around the top of the stomach. The band is connected to a subcutaneous port that can be used to inflate the band, increasing the restriction on the stomach. Each procedure is associated with benefits and risks; therefore, the purpose of this review is to compare the clinical effectiveness, safety, and cost-effectiveness of the RYGB, SG, and LAGB procedures amongst one another in obese and morbidly obese patients. This report builds on a Rapid Response report completed in August 2013, which focused on the evidence for prioritizing patients for bariatric surgery.