Bariatric surgery: a systematic review and network meta-analysis of randomized trials

被引:187
作者
Padwal, R. [1 ]
Klarenbach, S. [1 ]
Wiebe, N. [1 ]
Birch, D. [2 ]
Karmali, S. [2 ]
Manns, B. [3 ]
Hazel, M. [1 ]
Sharma, A. M. [1 ]
Tonelli, M. [1 ]
机构
[1] Univ Alberta, Dept Med, Edmonton, AB T6B 2B7, Canada
[2] Univ Alberta, Dept Surg, Edmonton, AB T6B 2B7, Canada
[3] Univ Calgary, Dept Med, Calgary, AB, Canada
基金
加拿大健康研究院;
关键词
Bariatric surgery; obesity; network meta-analysis; VERTICAL BANDED GASTROPLASTY; ROUX-EN-Y; LAPAROSCOPIC GASTRIC BYPASS; CARDIOVASCULAR RISK-FACTORS; QUALITY-OF-LIFE; MORBID-OBESITY; SLEEVE GASTRECTOMY; CLINICAL-TRIAL; DIET; JEJUNOILEAL;
D O I
10.1111/j.1467-789X.2011.00866.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The clinical efficacy and safety of bariatric surgery trials were systematically reviewed. MEDLINE, EMBASE, CENTRAL were searched to February 2009. A basic PubCrawler alert was run until March 2010. Trial registries, HTA websites and systematic reviews were searched. Manufacturers were contacted. Randomized trials comparing bariatric surgeries and/or standard care were selected. Evidence-based items potentially indicating risk of bias were assessed. Network meta-analysis was performed using Bayesian techniques. Of 1838 citations, 31 RCTs involving 2619 patients (mean age 30-48 y; mean BMI levels 42-58 kg/m(2)) met eligibility criteria. As compared with standard care, differences in BMI levels from baseline at year 1 (15 trials; 1103 participants) were as follows: jejunoileal bypass [MD: -11.4 kg/m(2)], mini-gastric bypass [-11.3 kg/m(2)], biliopancreatic diversion [-11.2 kg/m(2)], sleeve gastrectomy [-10.1 kg/m(2)], Roux-en-Y gastric bypass [-9.0 kg/m(2)], horizontal gastroplasty [-5.0 kg/m(2)], vertical banded gastroplasty [-6.4 kg/m(2)], and adjustable gastric banding [-2.4 kg/m(2)]. Bariatric surgery appears efficacious compared to standard care in reducing BMI. Weight losses are greatest with diversionary procedures, intermediate with diversionary/restrictive procedures, and lowest with those that are purely restrictive. Compared with Roux-en-Y gastric bypass, adjustable gastric banding has lower weight loss efficacy, but also leads to fewer serious adverse effects.
引用
收藏
页码:602 / 621
页数:20
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