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Review
. 2024 Jan 23;16(1):e52796.
doi: 10.7759/cureus.52796. eCollection 2024 Jan.

Comparing Safety and Efficacy Outcomes of Gastric Bypass and Sleeve Gastrectomy in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Mohamed Elsaigh  1 , Bakhtawar Awan  1 , Ahmed Shabana  2 , Azka Sohail  1 , Ahmad Asqalan  3 , Omnia Saleh  4 , Justyna Szul  1 , Rana Khalil  5 , Hatem Elgohary  6 , Mohamed Marzouk  1 , Mohamed Alasmar  7
Affiliations
Review

Comparing Safety and Efficacy Outcomes of Gastric Bypass and Sleeve Gastrectomy in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Mohamed Elsaigh et al. Cureus. .

Abstract

Sleeve Gastrectomy (SG) could be done by the removal of a big portion of the stomach, leading to reduced amounts of food taken as a result of the smaller stomach size. In contrast, Roux-en-Y Gastric Bypass (RYGB) can be done by creating a small stomach pouch and rerouting a part of the small intestine, employing combined mechanisms of restriction and malabsorption to limit food intake and modify nutrient absorption. Our aim is to identify the most effective and safest surgical intervention for individuals with both Type 2 Diabetes Mellitus (T2DM) and obesity, considering both short and long-term outcomes. We will assess participants undergoing either SG or RYGB to determine the optimal surgical approach. We made a thorough search of PubMed, Cochrane Library, Scopus, and Web of Science databases up to November 2023. Our focus was on randomized controlled trials (RCTs) comparing the safety and efficacy of RYGB and SG in T2DM regarding any extractable data. We excluded studies of other designs, such as cohorts, case reports, case series, reviews, in vitro studies, postmortem analyses, and conference abstracts. Utilizing Review Manager 5.4, we performed a meta-analysis, combining risk ratios (RR) with a 95% confidence interval (CI) conducted for binary outcomes, while mean with SD and 95% CI are pooled for the continuous ones. The total number of participants in our study is 4,148 patients. Our analysis indicates superior outcomes in the group undergoing RYGB surgery compared to the SG group (RR = 0.76, 95% (CI) (0.66 to 0.88), P = 0.0002). The pooled data exhibited homogeneity (P = 0.51, I2 = 0%) after employing the leave-one-out method. For the 1-3 year period, six studies involving 332 patients with T2DM yielded non-significant results (RR = 0.83, 95% CI (0.66 to 1.06), P = 0.14) with homogeneity (P = 0.24, I2 = 28%). Conversely, the 5-10 year period, with six studies comprising 728 DM patients, demonstrated significant results (RR = 0.69, 95% CI (0.56 to 0.85), P = 0.14) and homogeneity (P = 0.84, I2 = 0%). In terms of total body weight loss, our findings indicate significantly higher weight loss with RYGB (mean difference (MD) = -6.13, 95% CI (-8.65 to -3.6), P > 0.00001). However, pooled data exhibited considerable heterogeneity (P > 0.00001, I2 = 93%). Subgroup analyses for the 1-3 year period (five studies, 364 DM patients) and 5-10 year period (six studies, 985 DM patients) also revealed significant differences favoring RYGB, with heterogeneity observed in both periods (1-3 years: P > 0.00001, I2 = 95%; 5-10 years: P = 0.001, I2 = 75%). RYGB demonstrated significant long-term improvement in diabetes remission and superior total body weight loss compared to SG. While no notable differences were observed in other efficacy outcomes, safety parameters require further investigation. no significant distinctions were found in any of the safety outcomes: hypertension (HTN), high-density lipoprotein (HDL), hyperlipidemia, fasting blood glucose, vomiting, low-density lipoprotein (LDL), and total cholesterol. Further research is essential to comprehensively assess safety outcomes for both surgical approaches.

Keywords: gastric bypass surgery; gastric sleeve surgery; systematic review and meta analysis; type2 diabetes mellitus; weight loss and obesity.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA Flow diagram
Figure 2
Figure 2. ROB summary [29-51]
ROB: Risk of bias
Figure 3
Figure 3. Risk of bias graph
Figure 4
Figure 4. Diabetes remission [32-34,36,38-44,46]
The data has been presented in numbers and percentages.
Figure 5
Figure 5. HbA1c [31-34,37,41,42,44]
The data has been represented as mean ± SD.
Figure 6
Figure 6. Total body weight loss [31,32,34,35,37,38,40-44]
The data has been represented as mean ± SD.
Figure 7
Figure 7. BMI [33-37,39,41,42,44]
The data has been represented as mean ± SD.
Figure 8
Figure 8. QoL [29,38,41,43]
The data has been represented as mean ± SD.
Figure 9
Figure 9. Fasting glucose [30,31,33-35,40,43,45,51]
The data has been represented as mean ± SD.
Figure 10
Figure 10. Dyslipidimia [34,38,40,42]
The data has been represented as numbers and percentages.
Figure 11
Figure 11. Total cholesterol [29,30,33,38,42,44]
The data has been represented as mean ± SD.
Figure 12
Figure 12. HDL [30,33,37,38,42-44]
The data has been represented as mean ± SD. HDL: High-density lipoprotein
Figure 13
Figure 13. LDL [30,33,37,38,42-44]
The data has been represented as mean ± SD. LDL: Low-density lipoprotein
Figure 14
Figure 14. HTN [29,34,38,40,42]
The data has been represented as numbers and percentages. HTN: Hypertension
Figure 15
Figure 15. Vomiting [36,39,40]
The data has been represented as numbers and percentages.
See this image and copyright information in PMC

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