Laparoscopic Roux-en-Y Gastric Bypass versus Laparoscopic Sleeve Gastrectomy for Obesity and Type 2 Diabetes Mellitus: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 YANYong ¹ , SHAYan-hua ² , LIXu-zhong ³ , WANGShi-guang ¹ , ZHOUZhou ⁴ , HUCheng ⁴ ,  ZHANGXue-li ¹

1. Department of General Surgery, Central Hospital of Fengxian District, Southern Medical University, Shanghai 201499, China;
2. Laboratory Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;
3. Department of General Surgery, Puyang Oilfield General Hospital, Puyang 457001, China;
4. Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China;

Corresponding author：

ZHANGXue-li, Email: lejing1996@aliyun.com

Keywords：

Bariatric surgery; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic sleeve gastrectomy; Obesity; Type 2 diabetes mellitus; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150195

Video：

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Objective To systematically review the efficacy and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) versus laparoscopic sleeve gastrectomy (LSG) for obesity and type 2 diabetes mellitus (T2DM). Methods We searched PubMed, EMbase, The Cochrane Library (Issue 8, 2014), CNKI and WanFang Data from inception to December 2014, to collect randomized controlled trials (RCTs) of LRYGB vs. LSG for obesity and T2DM. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 8 RCTs including 828 patients were included. The results of meta-analysis showed that:There were no significant differences between the LRYGB group and the LSG group in body mass index (MD=-1.02, 95%CI -2.90 to 0.86, P=0.29), remission rate of T2DM (OR=1.11, 95%CI 0.71 to 1.73, P=0.64), reoperation rate (OR=2.74, 95%CI 1.01 to 7.42, P=0.05), level of fasting plasma glucose (MD=2.71, 95%CI -0.80 to 6.21, P=0.13), and level of serum low density lipoprotein (MD=-23.85, 95%CI -47.20 to -0.50, P=0.05). However, the LSG group had lower postoperative complication rate (OR=2.28, 95%CI 1.43 to 3.62, P=0.000 5) than that of the LRYGB group. Conclusion In short term, both LRYGB and LSG were equally efficient in the treatment of obesity and T2DM, but LSG has lower postoperative complication rate than LRYGB. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： YANYong, SHAYan-hua, LIXu-zhong, WANGShi-guang, ZHOUZhou, HUCheng, ZHANGXue-li. Laparoscopic Roux-en-Y Gastric Bypass versus Laparoscopic Sleeve Gastrectomy for Obesity and Type 2 Diabetes Mellitus: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(10): 1174-1181. doi: 10.7507/1672-2531.20150195 Copy

1.	Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med, 2010, 362(12):1090-1101.
2.	Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes, 2014, 7:587-591.
3.	Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity:a systematic review and meta-analysis of randomized controlled trials. BMJ, 2013, 347:f5934.
4.	Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ, 2014, 349:g3961.
5.	Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet, 2012, 379(9833):2300-2311.
6.	邹大进, 郑成竹, 吴鸿, 等. 手术治疗糖尿病专家共识. 中国实用外科杂志, 2011, (5):367-370.
7.	Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China:a 5-year outcome. Obes Surg, 2014, 24(10):1617-1624.
8.	Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med, 2014, 370(21):2002-2013.
9.	Vix M, Diana M, Liu KH, et al. Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass:results of a prospective randomized clinical trial. Obes Surg, 2013, 23(5):613-621.
10.	Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes:a randomised trial. Diabetologia, 2013, 56(9):1914-1918.
11.	Helmio M, Victorzon M, Ovaska J, et al. SLEEVEPASS:a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity:preliminary results. Surg Endosc, 2012, 26(9):2521-2526.
12.	Peterli R, Borbely Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS):a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg, 2013, 258(5):690-694, 695.
13.	Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI＜50 kg/m². Obes Surg, 2011, 21(11):1650-1656.
14.	Nogues X, Goday A, Pena MJ, et al.[Bone mass loss after sleeve gastrectomy:a prospective comparative study with gastric bypass]. Cir Esp, 2010, 88(2):103-109.
15.	Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med, 2004, 351(26):2683-2693.
16.	Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care, 2008, 31(Suppl 2):S290-S296.
17.	Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg, 2011, 253(3):484-487.
18.	Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit consensus conference:recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg, 2010, 251(3):399-405.
19.	Nadalini L, Zenti MG, Masotto L, et al. Improved quality of life after bariatric surgery in morbidly obese patients. Interdisciplinary group of bariatric surgery of Verona (G.I.C.O.V.). G Chir, 2014, 35(7-8):161-164.
20.	Zhang C, Yuan Y, Qiu C, et al. A meta-analysis of 2-year effect after surgery:laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus. Obes Surg, 2014, 24(9):1528-1535.
21.	Yang X, Yang G, Wang W, et al. A meta-analysis:to compare the clinical results between gastric bypass and sleeve gastrectomy for the obese patients. Obes Surg, 2013, 23(7):1001-1010.
22.	Wang MC, Guo XH, Zhang YW, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes:a meta-analysis of randomized controlled trials. Am Surg, 2015, 81(2):166-171.
23.	Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes:a systematic review and meta-analysis of outcomes. Obes Surg, 2013, 23(12):1994-2003.
24.	Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg, 2015, 25(10):1822-1832.
25.	Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network:laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg, 2011, 254(3):410-420.
26.	谢晓峰, 张文亮, 李倩, 等. 外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析. 中国循证医学杂志, 2013, 13(6):728-734.
27.	Rao BB, Bhattacharya A, Agrawal V. Renal outcomes of bariatric surgery in obese adults with diabetic kidney disease. J Nephrol, 2014, 27(4):361-370.
28.	Thomas RL, Prior SL, Barry JD, et al. Does bariatric surgery adversely impact on diabetic retinopathy in persons with morbid obesity and type 2 diabetes? A pilot study. J Diabetes Complications, 2014, 28(2):191-195.
29.	Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA, 2015, 313(1):62-70.
30.	Ryan KK, Tremaroli V, Clemmensen C, et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature, 2014, 509(7499):183-188.
31.	Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science, 2013, 341(6144):406-410.

1. Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med, 2010, 362(12):1090-1101.
2. Al-Goblan AS, Al-Alfi MA, Khan MZ. Mechanism linking diabetes mellitus and obesity. Diabetes Metab Syndr Obes, 2014, 7:587-591.
3. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity:a systematic review and meta-analysis of randomized controlled trials. BMJ, 2013, 347:f5934.
4. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ, 2014, 349:g3961.
5. Dixon JB, le Roux CW, Rubino F, et al. Bariatric surgery for type 2 diabetes. Lancet, 2012, 379(9833):2300-2311.
6. 邹大进, 郑成竹, 吴鸿, 等. 手术治疗糖尿病专家共识. 中国实用外科杂志, 2011, (5):367-370.
7. Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China:a 5-year outcome. Obes Surg, 2014, 24(10):1617-1624.
8. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes-3-year outcomes. N Engl J Med, 2014, 370(21):2002-2013.
9. Vix M, Diana M, Liu KH, et al. Evolution of glycolipid profile after sleeve gastrectomy vs. Roux-en-Y gastric bypass:results of a prospective randomized clinical trial. Obes Surg, 2013, 23(5):613-621.
10. Keidar A, Hershkop KJ, Marko L, et al. Roux-en-Y gastric bypass vs sleeve gastrectomy for obese patients with type 2 diabetes:a randomised trial. Diabetologia, 2013, 56(9):1914-1918.
11. Helmio M, Victorzon M, Ovaska J, et al. SLEEVEPASS:a randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity:preliminary results. Surg Endosc, 2012, 26(9):2521-2526.
12. Peterli R, Borbely Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS):a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg, 2013, 258(5):690-694, 695.
13. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI＜50 kg/m². Obes Surg, 2011, 21(11):1650-1656.
14. Nogues X, Goday A, Pena MJ, et al.[Bone mass loss after sleeve gastrectomy:a prospective comparative study with gastric bypass]. Cir Esp, 2010, 88(2):103-109.
15. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med, 2004, 351(26):2683-2693.
16. Rubino F. Is type 2 diabetes an operable intestinal disease? A provocative yet reasonable hypothesis. Diabetes Care, 2008, 31(Suppl 2):S290-S296.
17. Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. a systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg, 2011, 253(3):484-487.
18. Rubino F, Kaplan LM, Schauer PR, et al. The Diabetes Surgery Summit consensus conference:recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg, 2010, 251(3):399-405.
19. Nadalini L, Zenti MG, Masotto L, et al. Improved quality of life after bariatric surgery in morbidly obese patients. Interdisciplinary group of bariatric surgery of Verona (G.I.C.O.V.). G Chir, 2014, 35(7-8):161-164.
20. Zhang C, Yuan Y, Qiu C, et al. A meta-analysis of 2-year effect after surgery:laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus. Obes Surg, 2014, 24(9):1528-1535.
21. Yang X, Yang G, Wang W, et al. A meta-analysis:to compare the clinical results between gastric bypass and sleeve gastrectomy for the obese patients. Obes Surg, 2013, 23(7):1001-1010.
22. Wang MC, Guo XH, Zhang YW, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for obese patients with Type 2 diabetes:a meta-analysis of randomized controlled trials. Am Surg, 2015, 81(2):166-171.
23. Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes:a systematic review and meta-analysis of outcomes. Obes Surg, 2013, 23(12):1994-2003.
24. Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery Worldwide 2013. Obes Surg, 2015, 25(10):1822-1832.
25. Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network:laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg, 2011, 254(3):410-420.
26. 谢晓峰, 张文亮, 李倩, 等. 外科减重手术与传统方法比较治疗肥胖患者2型糖尿病的Meta分析. 中国循证医学杂志, 2013, 13(6):728-734.
27. Rao BB, Bhattacharya A, Agrawal V. Renal outcomes of bariatric surgery in obese adults with diabetic kidney disease. J Nephrol, 2014, 27(4):361-370.
28. Thomas RL, Prior SL, Barry JD, et al. Does bariatric surgery adversely impact on diabetic retinopathy in persons with morbid obesity and type 2 diabetes? A pilot study. J Diabetes Complications, 2014, 28(2):191-195.
29. Arterburn DE, Olsen MK, Smith VA, et al. Association between bariatric surgery and long-term survival. JAMA, 2015, 313(1):62-70.
30. Ryan KK, Tremaroli V, Clemmensen C, et al. FXR is a molecular target for the effects of vertical sleeve gastrectomy. Nature, 2014, 509(7499):183-188.
31. Saeidi N, Meoli L, Nestoridi E, et al. Reprogramming of intestinal glucose metabolism and glycemic control in rats after gastric bypass. Science, 2013, 341(6144):406-410.

Chinese Journal of Evidence-Based Medicine

Laparoscopic Roux-en-Y Gastric Bypass versus Laparoscopic Sleeve Gastrectomy for Obesity and Type 2 Diabetes Mellitus: A Meta-analysis

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