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Meta-Analysis
. 2022 Mar;30(3):614-627.
doi: 10.1002/oby.23338. Epub 2022 Feb 8.

Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials

Isabelle Uhe  1 , Jonathan Douissard  1 , Michele Podetta  1 , Mickael Chevallay  1 , Christian Toso  1 , Minoa Karin Jung  1 , Jeremy Meyer  1
Affiliations
Meta-Analysis

Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials

Isabelle Uhe et al. Obesity (Silver Spring). 2022 Mar.

Abstract

Objective: This study aimed to determine which bariatric procedure allows patients to obtain the best weight-loss outcomes and a remission of type 2 diabetes.

Methods: Databases were searched for randomized-controlled trials comparing Roux-en-Y gastric bypass (RYGB) with sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB). The mean difference (MD) or the relative risk was determined.

Results: Twenty-five randomized-controlled trials were analyzed. Excess weight loss (EWL, percentage) was greater for RYGB patients at 3 years (MD: 11.93, p < 0.00001) and 5 years (MD: 13.11, p = 0.0004). Higher excess BMI loss (percentage) was found in RYGB at 1 year (MD: 11.66, p = 0.01). Total weight loss (percentage) was greater for RYGB patients after 3 months (MD: 2.41, p = 0.02), 6 months (MD: 3.83, p < 0.00001), 1 year (MD: 6.35, p < 0.00001), and 5 years (MD: 3.90, p = 0.005). No difference in terms of remission of type 2 diabetes was seen between RYGB and SG. EWL was significantly more important after OAGB than after RYGB after 1 year (MD: -10.82, p = 0.003).

Conclusions: RYGB is more efficient than SG in the midterm. OAGB offers greater EWL than RYGB after 1 year, but further evidence is needed to confirm this result.

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Conflict of interest statement

The authors declared no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Forest plot comparing TWL (percentage) between RYGB and SG at (A) 1 month after surgery; (B) 3 months after surgery; (C) 6 months after surgery; (D) 1 year after surgery; and (E) 5 years after surgery. The vertical line represents the null effect. Each horizontal line represents the 95% CI of one study. The size of the green box is related to the weight of each study. The diamond symbolizes the overall effect of all the studies. RYGB, Roux‐en‐Y gastric bypass; SG, sleeve gastrectomy; TWL, total weight loss [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Forest plot comparing EWL (percentage) between RYGB and SG at (A) 1 month after surgery; (B) 3 months after surgery; (C) 6 months after surgery; (D) 1 year after surgery; (E) 2 years after surgery; (F) 3 years after surgery; and (G) 5 years after surgery. The vertical line represents the null effect. Each horizontal line represents the 95% CI of one study. The size of the green box is related to the weight of each study. The diamond symbolizes the overall effect of all the studies. EWL, excess weight loss; RYGB, Roux‐en‐Y gastric bypass; SG, sleeve gastrectomy [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Forest plot comparing EWL (percentage) between RYGB and OAGB at (A) 6 months after surgery; and (B) 1 year after surgery. The vertical line represents the null effect. Each horizontal line represents the 95% CI of one study. The size of the green box is related to the weight of each study. The diamond symbolizes the overall effect of all the studies. EWL, excess weight loss; OAGB, one‐anastomosis gastric bypass; RYGB, Roux‐en‐Y gastric bypass [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Forest plot of the network meta‐analysis for EWL (percentage) at 12 months, MD, mean difference; OAGB, one‐anastomosis gastric bypass; RYGB, Roux‐en‐Y gastric bypass; SG, sleeve gastrectomy
FIGURE 5
FIGURE 5
Forest plot comparing excess body mass index loss (percentage) at (A) 1 month after surgery; (B) 3 months after surgery; (C) 1 year after surgery; (D) 2 years after surgery; and (E) 5 years after surgery. The vertical line represents the null effect. Each horizontal line represents the 95% CI of one study. The size of the green box is related to the weight of each study. The diamond symbolizes the overall effect of all the studies. RYGB, Roux‐en‐Y gastric bypass; SG, sleeve gastrectomy [Colour figure can be viewed at wileyonlinelibrary.com]
FIGURE 6
FIGURE 6
Forest plot comparing remission of type 2 diabetes between RYGB and SG at (A) 1 month after surgery; (B) 3 months after surgery; (C) 6 months after surgery; (D) 1 year after surgery; (E) 2 years after surgery; (F) 3 years after surgery; and (G) 5 years after surgery. The vertical line represents the null effect. Each horizontal line represents the 95% CI of one study. The size of the green box is related to the weight of each study. The diamond symbolizes the overall effect of all the studies. RYGB, Roux‐en‐Y gastric bypass; SG, sleeve gastrectomy [Colour figure can be viewed at wileyonlinelibrary.com]
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