Banded versus non-banded sleeve gastrectomy in obese patients: A systematic review & meta-analysis

Abstract

Background & aims: Weight regain represents an important issue after sleeve gastrectomy (SG), hence banded sleeve gastrectomy (BSG) was proposed. Aim of this meta-analysis was to compare the performance ofBSG versus SG in obese patients.

Methods: We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized-controlled trials (recruiting673 patients). The primary outcome was % excess weight loss (%EWL); secondary outcomes included % total weight loss (%TWL), HbA1c improvement, overall complication and major complication rate, gastro-esophageal reflux disease (GERD)occurrence. We performed pairwise meta-analysis through a random effects model and expressed data as standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI).

Results: A sharp decline in %EWL at 1 year was observed with both treatments with no significant difference (SMD 5.99, -1.17 to 13.16), whereas a clear benefit with BSG over SG was observed over time (SMD 15.95, 13.31 to 18.58 at 2 years; 18.37, 13.31 to 23.42 at 3 years; 24.75, 22.38 to 27.12 at 4 years; 29.85, 27.22 to 32.49 at 5 years). Meta-regression did not find any significant correlations between age, sex, and baseline BMI with %EWL. Similarly, no difference in terms of %TWL was observed at 1 year (SMD 1, -3.31 to 5.30), whereas the magnitude of the benefit with BSG increased significantly from the second year onwards (SMD 5.99, 3.7 to 8.27 at 2 year, 6.86, 5.13 to 8.59 at 3 year, and 9.36, 7.07 to 11.65 at 5 year). No difference in terms of HbA1c improvement was observed (SMD 0.40, -0.64 to 1.43). No difference in overall complication (OR 1.44, 0.55-3.76), major complications (OR 1.14, 0.52-1.87), and incidence of GERD was observed (OR 1.06, 0.56-2).

Conclusion: BSG is superior to SG in obese patients, due to its ability to significantly increase %EWL with no additional safety issues.

Keywords: BMI; Bariatric surgery; Diabetes; Reflux; Weight loss.