Comparison Of Efficacy And Safety Between Laparoscopic Sleeve Gastrectomy And Roux-En-Y Gastric Bypass In The Treatment Of Obesity: A Meta-Analysis

Objective:Laparoscopic sleeve gastrectomy(LSG)and laparoscopic Roux-En-Y gastric bypass(LRYGB)are the two most common weight-loss procedures.We aimed to systematically evaluate the efficacy and safety of LSG and LRYGB in the treatment of obesity.Methods:Pub Med,Embase,Cochrane library and Web of Science databases were searched for literatures related to the efficacy and safety of LSG and LRYGB in the treatment of obese.The deadline was October 2020.Two reviewers were employed to screen the literatures,extract data and conduct literature quality assessment.Meta-analysis was performed using Rev Man5.3software and stata 16 software.Results:9 RCTs with a total of 1,156 patients were included,including 580 patients in the LSG group and 576 patients in the LRYGB group.Meta-analysis results showed that there was no statistical significance in BMI changes between the LSG group and the LRYGB group(MD=-0.42,95%CI:-2.71～1.88,P=0.72),while there was statistical significance in postoperative %EWL(MD=-4.38,95%CI:-8.39～-0.37,P=0.03).The postoperative %EWL Subgroup analysis was conducted according to the follow-up time.The results showed that there was no statistical significance in postoperative %EWL during 0.5 to 1 year follow-up(MD=0.25,95%CI:-5.78～6.28,P=0.94),while there was statistical significance in postoperative %EWL during 2 to 5 year follow-up(MD=-7.85,95%CI:-11.02～-4.68,P < 0.00001).The resolution rate of hypertension,T2 DM and dyslipidemia was statistically significant between the LSG group and the LRYGB group(OR=0.68,95%CI: 0.48～0.95,P=0.02;OR=0.46,95%CI:0.30～0.70,P=0.0003;OR=0.61,95%CI: 0.41～0.89,P=0.01),while resolution rate of osteoarthritis and sleep apnea syndrome was no statistically significant(OR=0.71,95 % CI : 0.25～1.98,P=0.51;OR=1.56,95%CI : 0.88～2.76,P=0.12).The incidence of postoperative complications and reoperation was no statistically significant(OR=0.52,95%CI:0.38～0.72,P<0.0001;OR=0.49,95%CI:0.30～0.81,P<0.005).Conclusion:Both LSG and LRYGB had a good effect on weight loss effect for obese patients.In the postoperative short term,LRYGB and LSG had the same weight loss effect.LRYGB was superior to LSG in postoperative middle-term and long-term weight loss.In terms of resolution rate of obesity comorbidities,LRYGB was generally better than LSG,especially for obese patients with T2 DM,hypertension,dyslipidemia.In terms of incidence of postoperative complications and reoperation,LSG was better than LRYGB.LSG is safer.