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. 2019 Jul;29(7):2180-2190.
doi: 10.1007/s11695-019-03831-6.

Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus: a Systematic Review and Network Meta-Analysis

Chan Hyuk Park #  1 , Seung-Joo Nam #  2 , Hyuk Soon Choi  3 , Kyoung Oh Kim  4 , Do Hoon Kim  5 , Jung-Wook Kim  6 , Won Sohn  7 , Jai Hoon Yoon  8 , Sung Hoon Jung  9 , Yil Sik Hyun  10 , Hang Lak Lee  11 ; Korean Research Group for Endoscopic Management of Metabolic Disorder and Obesity
Affiliations

Comparative Efficacy of Bariatric Surgery in the Treatment of Morbid Obesity and Diabetes Mellitus: a Systematic Review and Network Meta-Analysis

Chan Hyuk Park et al. Obes Surg. 2019 Jul.

Abstract

Introduction: The comparative efficacy of various bariatric procedures has not been completely elucidated. We aimed to evaluate efficacy and safety of various bariatric procedures comprehensively.

Methods: We searched for randomized controlled trials investigating the efficacy of bariatric surgery. Network meta-analyses were performed to determine the percentage of excess weight loss (%EWL) and remission of diabetes mellitus (DM).

Results: Of 45 studies, 33 and 24 provided the data for %EWL and DM remission rates, respectively. Six months after surgery, biliopancreatic diversion with duodenal switch (BPD-DS), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) showed superior efficacy for %EWL compared to the standard-of-care (mean difference [MD], [95% confidence interval [CI]]: BPD-DS, 38.2% [7.3%, 69.1%]; RYGB, 32.1% [3.1%, 61.1%]; SG, 32.5% [5.5%, 59.5%]). However, adjustable gastric banding was not superior to standard-of-care (MD [95% CI] = - 0.2% [- 19.6%, 19.2%]). At 1 year, all bariatric procedures were superior to standard-of-care. At 3 years, RYGB and SG showed superior efficacy when compared to standard-of-care (MD [95% CI]: RYGB, 45.0% [21.8%, 68.2%]; SG, 39.2% [15.2%, 63.3%]). With respect to DM remission 3-5 years after surgery, BPD-DS, RYGB, and SG were superior to standard-of-care. Hernias, obstruction/stricture, bleeding, and ulcers were less common in patients who underwent SG than in those who underwent RYGB.

Conclusions: RYGB and SG had excellent long-term outcomes for both the %EWL and DM remission rates. Additionally, SG had a relatively lower risk of adverse events than RYGB.

Keywords: Bariatric surgery; Diabetes; Excessive weight loss; Metabolic surgery; Network meta-analysis.

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