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Meta-Analysis
. 2023 Mar 1;109(3):277-286.
doi: 10.1097/JS9.0000000000000203.

Does one-anastomosis gastric bypass provide better outcomes than sleeve gastrectomy in patients with BMI greater than 50? A systematic review and meta-analysis

Maryam Barzin  1 , Amir Ebadinejad  1 , Ali Aminian  2 , Alireza Khalaj  3 , Faranak Ghazy  1 , Fatemeh Koohi  1 , Farhad Hosseinpanah  1 , Amirhossein Ramezani Ahmadi  4 , Majid Valizadeh  1 , Behnaz Abiri  1
Affiliations
Meta-Analysis

Does one-anastomosis gastric bypass provide better outcomes than sleeve gastrectomy in patients with BMI greater than 50? A systematic review and meta-analysis

Maryam Barzin et al. Int J Surg. .

Abstract

In patients with BMI greater than 50, sleeve gastrectomy (SG) may not be adequate to treat obesity. To determine whether one-anastomosis gastric bypass (OAGB) can provide better outcomes compared with SG in patients with BMI greater than 50, a systematic review and meta-analysis was conducted, including a total of nine retrospective studies with a total of 2332 participants. There was a significant difference in the percentage of excess weight loss [weighted mean difference (WMD): 8.52; 95% CI: 5.81-11.22; P<0.001) and percentage of total weight loss (WMD: 6.65; 95% CI: 5.05-8.24; P<0.001). No significant differences were seen in operative time (WMD: 1.91; 95% CI: -11.24 to 15.07; P=0.77) and length of stay in hospital (WMD: -0.41; 95% CI: -1.18 to 0.37; P=0.30) between the two groups. There were no significant differences between OAGB with SG in Clavien-Dindo grades I-III [odds ratio (OR): 1.56; 95% CI: 0.80-3.05], or grade IV complications (OR: 0.72; 95% CI: 0.18-2.94). The meta-analysis on remission of type 2 diabetes indicated a comparable effect between SG and OAGB (OR: 0.77; 95% CI: 0.28-2.16). The OAGB group had a significantly higher rate of remission of hypertension compared with the SG group (OR: 1.63; 95% CI: 1.06-2.50). The findings of this meta-analysis suggest that the OAGB accomplished a higher percentage of total weight loss and percentage of excess weight loss at short-term and mid-term follow-up but, there was no major difference between the OAGB and SG operations in terms of perioperative outcomes, complications, and diabetes remission.

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Conflict of interest statement

No conflict of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the selection process of the studies. OAGB, one-anastomosis gastric bypass; RYGB, Roux-en-Y gastric bypass.
Figure 2
Figure 2
Forest plot of pooled weighted mean difference (WMD) and its 95% CI for studies comparing one-anastomosis gastric bypass with sleeve gastrectomy in the percentage of excess weight loss by postoperative follow-up period. The right side of the vertical line refers to more percentage of excess weight loss for one-anastomosis gastric bypass than sleeve gastrectomy and vice versa.
Figure 3
Figure 3
Forest plot of pooled weighted mean difference (WMD) and its 95% CI for studies comparing one-anastomosis gastric bypass with sleeve gastrectomy in the percentage of total weight loss by postoperative follow-up period. The right side of the vertical line refers to more percentage of total weight loss for one-anastomosis gastric bypass than sleeve gastrectomy and vice versa.
Figure 4
Figure 4
Forest plot of pooled weighted mean difference (WMD) and its 95% CI for studies comparing one-anastomosis gastric bypass (OAGB) with sleeve gastrectomy (SG) in operation time. The right side of the vertical line refers to a longer operation time for OAGB than SG and the left side refers to a shorter operation time for OAGB than SG.
Figure 5
Figure 5
Forest plot of pooled standardized mean difference (SMD) and its 95% CI for studies comparing one-anastomosis gastric bypass (OAGB) with sleeve gastrectomy (SG) in operation time. The right side of the vertical line refers to a longer operation time for OAGB than SG and the left side refers to a shorter operation time for OAGB than SG (sensitivity analysis after removing Rajan’s study).
Figure 6
Figure 6
Forest plot of weighted mean difference (WMD) and its 95% CI for studies comparing one-anastomosis gastric bypass (OAGB) with sleeve gastrectomy (SG) in the length of stay in hospital. The right side of the vertical line refers to a longer length of stay in the hospital for OAGB than SG and the left side refers to a shorter length of stay in the hospital for OAGB than SG.
Figure 7
Figure 7
Forest plot of odds ratio (OR) and its 95% CI for studies comparing one-anastomosis gastric bypass with sleeve gastrectomy in Clavien–Dindo classification grades I–III (panel A) and Clavien–Dindo classification grade IV (panel B). The right side of the vertical line refers to more Clavien–Dindo classification grades for one-anastomosis gastric bypass compared to sleeve gastrectomy and vice versa.
Figure 8
Figure 8
Forest plot of odds ratio (OR) and its 95% CI for studies comparing one-anastomosis gastric bypass with sleeve gastrectomy in obesity-related comorbidities resolution; panel A, diabetes; panel B, hypertension. The right side of the vertical line refers to more comorbidities resolution for one-anastomosis gastric bypass compared to sleeve gastrectomy and vice versa.
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