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Meta-Analysis
. 2019 Jan;29(1):3-14.
doi: 10.1007/s11695-018-3525-0.

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding

Paul E O'Brien  1   2 , Annemarie Hindle  3 , Leah Brennan  3 , Stewart Skinner  4   5 , Paul Burton  4   5 , Andrew Smith  5 , Gary Crosthwaite  5 , Wendy Brown  4   5
Affiliations
Meta-Analysis

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding

Paul E O'Brien et al. Obes Surg. 2019 Jan.

Abstract

Introduction: Durability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.

Methods: Systematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.

Results: Systematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/- duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.

Conclusion: All current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.

Keywords: 20-year follow-up; Bariatric surgery; Long term; Meta-analysis; Reoperation rates; Weight loss.

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Conflict of interest statement

Conflict of Interest

Dr. O’Brien reports grants from Allergan Inc., grants from Apollo Endosurgery and grants from Applied Medical during the conduct of the study.

Dr. Brown reports grants from Johnson and Johnson, grants from Medtronic, grants from GORE, personal fees from GORE, grants from Applied Medical, grants from Apollo Endosurgery, grants and personal fees from Novo Nordisc and personal fees from Merck Sharpe and Dohme.

There were no other reported conflicts of interest.

Informed Consent

Informed consent was not applicable or required for this study.

Figures

Fig. 1
Fig. 1
The flow diagram of the systematic review. The eligible articles from the earlier systematic review [4] are added at the level of included studies
Fig. 2
Fig. 2
Forest plot of long-term effect of RYGB on %EWL
Fig. 3
Fig. 3
Forest plot of long-term effect of LAGB on %EWL. The RCTs were Angrisani 2013 and O’Brien 2013b
Fig. 4
Fig. 4
Forest plot of BPD ± DS. The studies of Ballesteos-Pomar 2016 and Larrad-Jiminez 2007 were of BPD alone
Fig. 5
Fig. 5
The weight loss expressed as %EWL ± 95% CI for the 20-year period of follow-up after LAGB. The initial N = 8378 patients. At 20 years, there was 30.1 kg weight loss and 22.2%TWL
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