Treatment options for weight regain or insufficient weight loss after sleeve gastrectomy: a systematic review and meta-analysis
EAES Academy. Franken R. 07/05/22; 366536; P279
CLICK HERE TO LOGIN
REGULAR CONTENT
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Obesity has reached pandemic proportions over the last decades. Bariatric surgery is the most effective treatment for obesity. Weight failure after sleeve gastrectomy (SG) is frequently observed (10-35%). Consensus on the most effective treatment is lacking. The aim of this meta-analysis was to assess revisional strategies for weight regain (WR) or insufficient weight loss (IWL) following SG.
A literature search (in PubMed and Embase) of revision interventions after SG was performed from inception up to May 04, 2021.
Twenty-two studies (1342 patients) were included. Two studies reported on endoscopic gastroplasty (ESG), five on re-sleeve gastrectomy (re-SG), six on Roux-en-Y gastric bypass (RYGB), eight on one anastomosis gastric bypass (OAGB), three on single anastomosis duodeno-ileal bypass (SADI) and one duodenal switch (DS). All techniques resulted in weight loss (Figure 1). OAGB was most effective. Pooled BMI at revision was 41,78 kg/m2 (95% CI, 40.53 – 43.02) and reduction was 11.48 kg/m2 (95% CI, 8.03 – 14.92), 14.43 kg/m2 (95% CI, -33.17 – 62.02), 12.74 kg/m2 (95% CI, -0.94 – 26.42) and 17.80 kg/m2 (95% CI, 16.33 – 19.27) after 12, 24, 36 and > 48 months, respectively. OAGB was a relatively safe procedure with an incidence of major complications of 4.5% including 1.2% anastomotic leakage and minor complications in 2.3%. Endoscopic procedure were least effective but showed low complications rates. All other procedures were feasible but differed regarding complication rates. SADI and DS were associated with high complication rates.
Although our data suggest that revisional OAGB was the most effective procedure, Heterogeneity and poor follow-up rates precludes strong conclusions and clinical decision making. Controlled prospective trials with longer follow-up are needed in order to choose the best revisional treatment for long-term success. Choice of procedure is depending on patient’s characteristics and surgeons’ expertise.
A literature search (in PubMed and Embase) of revision interventions after SG was performed from inception up to May 04, 2021.
Twenty-two studies (1342 patients) were included. Two studies reported on endoscopic gastroplasty (ESG), five on re-sleeve gastrectomy (re-SG), six on Roux-en-Y gastric bypass (RYGB), eight on one anastomosis gastric bypass (OAGB), three on single anastomosis duodeno-ileal bypass (SADI) and one duodenal switch (DS). All techniques resulted in weight loss (Figure 1). OAGB was most effective. Pooled BMI at revision was 41,78 kg/m2 (95% CI, 40.53 – 43.02) and reduction was 11.48 kg/m2 (95% CI, 8.03 – 14.92), 14.43 kg/m2 (95% CI, -33.17 – 62.02), 12.74 kg/m2 (95% CI, -0.94 – 26.42) and 17.80 kg/m2 (95% CI, 16.33 – 19.27) after 12, 24, 36 and > 48 months, respectively. OAGB was a relatively safe procedure with an incidence of major complications of 4.5% including 1.2% anastomotic leakage and minor complications in 2.3%. Endoscopic procedure were least effective but showed low complications rates. All other procedures were feasible but differed regarding complication rates. SADI and DS were associated with high complication rates.
Although our data suggest that revisional OAGB was the most effective procedure, Heterogeneity and poor follow-up rates precludes strong conclusions and clinical decision making. Controlled prospective trials with longer follow-up are needed in order to choose the best revisional treatment for long-term success. Choice of procedure is depending on patient’s characteristics and surgeons’ expertise.
Obesity has reached pandemic proportions over the last decades. Bariatric surgery is the most effective treatment for obesity. Weight failure after sleeve gastrectomy (SG) is frequently observed (10-35%). Consensus on the most effective treatment is lacking. The aim of this meta-analysis was to assess revisional strategies for weight regain (WR) or insufficient weight loss (IWL) following SG.
A literature search (in PubMed and Embase) of revision interventions after SG was performed from inception up to May 04, 2021.
Twenty-two studies (1342 patients) were included. Two studies reported on endoscopic gastroplasty (ESG), five on re-sleeve gastrectomy (re-SG), six on Roux-en-Y gastric bypass (RYGB), eight on one anastomosis gastric bypass (OAGB), three on single anastomosis duodeno-ileal bypass (SADI) and one duodenal switch (DS). All techniques resulted in weight loss (Figure 1). OAGB was most effective. Pooled BMI at revision was 41,78 kg/m2 (95% CI, 40.53 – 43.02) and reduction was 11.48 kg/m2 (95% CI, 8.03 – 14.92), 14.43 kg/m2 (95% CI, -33.17 – 62.02), 12.74 kg/m2 (95% CI, -0.94 – 26.42) and 17.80 kg/m2 (95% CI, 16.33 – 19.27) after 12, 24, 36 and > 48 months, respectively. OAGB was a relatively safe procedure with an incidence of major complications of 4.5% including 1.2% anastomotic leakage and minor complications in 2.3%. Endoscopic procedure were least effective but showed low complications rates. All other procedures were feasible but differed regarding complication rates. SADI and DS were associated with high complication rates.
Although our data suggest that revisional OAGB was the most effective procedure, Heterogeneity and poor follow-up rates precludes strong conclusions and clinical decision making. Controlled prospective trials with longer follow-up are needed in order to choose the best revisional treatment for long-term success. Choice of procedure is depending on patient’s characteristics and surgeons’ expertise.
A literature search (in PubMed and Embase) of revision interventions after SG was performed from inception up to May 04, 2021.
Twenty-two studies (1342 patients) were included. Two studies reported on endoscopic gastroplasty (ESG), five on re-sleeve gastrectomy (re-SG), six on Roux-en-Y gastric bypass (RYGB), eight on one anastomosis gastric bypass (OAGB), three on single anastomosis duodeno-ileal bypass (SADI) and one duodenal switch (DS). All techniques resulted in weight loss (Figure 1). OAGB was most effective. Pooled BMI at revision was 41,78 kg/m2 (95% CI, 40.53 – 43.02) and reduction was 11.48 kg/m2 (95% CI, 8.03 – 14.92), 14.43 kg/m2 (95% CI, -33.17 – 62.02), 12.74 kg/m2 (95% CI, -0.94 – 26.42) and 17.80 kg/m2 (95% CI, 16.33 – 19.27) after 12, 24, 36 and > 48 months, respectively. OAGB was a relatively safe procedure with an incidence of major complications of 4.5% including 1.2% anastomotic leakage and minor complications in 2.3%. Endoscopic procedure were least effective but showed low complications rates. All other procedures were feasible but differed regarding complication rates. SADI and DS were associated with high complication rates.
Although our data suggest that revisional OAGB was the most effective procedure, Heterogeneity and poor follow-up rates precludes strong conclusions and clinical decision making. Controlled prospective trials with longer follow-up are needed in order to choose the best revisional treatment for long-term success. Choice of procedure is depending on patient’s characteristics and surgeons’ expertise.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}