| BACKGROUND and PURPOSE:Bariatric surgery is the most effective treatment for sustained weight loss in morbid obesity population.The most commonly performed procedure is gastric bypass. The objective of this study is to evaluate the outcomes of laparoscopic vs. open gastric bypass for morbid obesity with Systematic Review and Meta-analysis.METHODS:A systematic and comprehensive electronic search was conducted with hand-searched supplement.We searched PubMed, Cochrane Library, Ovid, Web of Science,China Journal Net Database, Chongqing VIP Network,using the following items:obesity/surgery OR gastric bypass OR anastomosis, Roux-en-Y OR Laparoscopic vs. Open Gastric Bypass.We evaluated the outcomes of laparoscopic vs. open gastric bypass for morbid obesity with surgical time,estimated blood loss, conversion rate,percentage of excess weight loss(%EWL), BMI(body mass index)change, hospital stay, re-operation rate, comorbidities,30-day readmission,30-day mortality and complications respectively.All statistical analyses were performed with Review Manager (RevMan 5.0).Results for continuous outcomes as weighted mean difference and dichotomous outcomes as odds ratios (OR) with 95% confidence intervals(CI) were expressed.Fixed and random effects meta-analysis were also used determined by the tests for heterogeneity.RESULTS:Results from meta-analysis showed that laparoscopic surgery had less blood loss(MD -256.95;95%CI -318.61 to -195.28; P<0.00001),shorter hospital stay(MD-1.23; 95%CI -1.62 to -0.84; P<0.00001), while the open surgery needed less surgical time(MD 30.00;95%CI 17.24 to 42.76; P<0.00001) and had lower re-operation rate(OR 1.79;95%CI 1.04 to 3.09).There were no differences in weight change(MD 0.09;95%CI 0.08 to 0.11),30-day readmission(95% CI 0.39 to 3.37) and 30-day mortality(95% CI 0.42 to 1.96).The results of each group is also different in complications.The overall incidence of complications is lower in laparoscopic group. Wound infection rate is lower after LGBP(OR 0.36;95%CI 0.28 to 0.46; P<0.00001),but higher in Anastomonic leak rate(OR 1.82;95% CI 1.28 to 2.58) and Bowl obstruction rate(OR 4.44;95% CI 1.09 to 18.14; P=0.04).The differences between two groups in Pneumonia rate(P=0.15),PE/DVT rate(OR 0.92;95% CI 0.37 to 2.30) and gastrointestinal hemorrhage(OR 1.44;95% CI 0.74 to 2.79)are not significant.CONCLUSION:In the short-term, laparoscopic gastric bypass procedure is as safe and effective as open gastric bypass procedure.There are,however, differences in the benefits and risks between the two procedures.Further high-quality, long follow-up period randomized controlled trials should be carried out to provide more reliable evidence. |
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