Systematic review and meta-analysis of medium-term outcomes after banded Roux-en-Y gastric bypass

H. Buchwald, J. N. Buchwald, T. W. McGlennon

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Abstract

This is the first systematic review and meta-analysis focused exclusively on intermediate-term outcomes for the banded Roux-en-Y gastric bypass (B-RYGB). B-RYGB articles published from 1990 to 2013 were identified through MEDLINE, ScienceDirect, and SpringerLink databases augmented by manual reference review. Articles were assigned an evidence level (Centre for Evidence-Based Medicine [Oxford UK] criteria) and Jadad quality score (randomized controlled trials). Simple and weighted means (95 % confidence interval (CI)) for excess weight loss (EWL) at follow-up (1-10+ years) were calculated. At 5 years, a pooled estimate for BMI (kg/m2) change (weighted mean difference and 95 % CI) for banded bypass patients was computed. Rates for weighted mean complications, non-band- and band-related reoperations, and overall comorbidity resolution were calculated. Three hundred twenty-one articles were identified: 286 failed inclusion criteria (i.e., non-English, B-RYGB unrelated, <10 per arm, <3-year follow-up), leaving 35 articles. Manual review added 10 potentially relevant articles; 30 that failed inclusion criteria were excluded, leaving 15 for analysis. B-RYGB was performed on 8,707 patients: 79.0 % female, mean age 38.7, and BMI 47.6 (41.0-59.4). Overall BMI weighted mean difference (reduction) at 5 years was 17.8 (95 % CI 12.8, 22.7; p<0.001). Five-year weighted mean EWL of 72.5 % (67.5, 77.4) was sustained at 10+ years (69.4 %; 58.9, 80.0). Weighted mean complication rates were as follows: early, 10.9 %, and late, 20.0 %. Non-band-related reoperation rate was 15.2 %, and band-specific reoperation rate was 4.1 %. Gastric outlet stenosis, band erosion, and band slippage were 2.8, 2.3, and 1.5 %, respectively. Diabetes remitted in 80/95 (84.2 %). By systematic review and meta-analysis, albeit with limited rates of follow-up, B-RYGB appeared to result in significant, sustained excess weight loss of approximately 70.0 % out to 10 years.

Original languageEnglish (US)
Pages (from-to)1536-1551
Number of pages16
JournalObesity Surgery
Volume24
Issue number9
DOIs
StatePublished - Sep 2014

Keywords

  • BMI
  • Banded gastric bypass
  • Bariatric surgery
  • Diabetes
  • Gastric bypass
  • Meta-analysis
  • Randomized controlled trial
  • Roux-en-Y
  • Systematic review
  • Weight

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