Comparison Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication Treatments for Obesity: an Updated Systematic Review and Meta-Analysis

Bariatric surgery has been widely performed to treat morbid obesity. Our meta-analysis aims to provide an updated comparison between laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP). Medline, EMBASE, Scopus, and Cochrane Central were searched. Ongoing clinical trials were identified from the clinicaltrials.gov website. References of the chosen literatures were manually reviewed for additional relevant studies. As a result, a total of 18 studies involving 1329 patients were selected. We demonstrated a significant higher excess weight loss (%EWL) after LSG at the 1-, 3-, 6-, 12-, and 18-month follow-up time points. However, no significant difference was found at 36 months. Body Mass Index Loss (BMIL) was better after LSG than LGCP at 12 and 24 months. The difference in the improvement of comorbidities (i.e., T2-DM, hypertension, and sleep apnea) did not reach statistical significance. The complications (i.e., bleeding, stenosis, leak, and abdominal pain), operative time, and length of hospital stay were comparable. More patients undergoing LGCP experienced nausea and vomiting. We obtained some different and new results compared to the previously published meta-analysis. Our meta-analysis showed significantly higher %EWL at 24 months (Z=2.08, p=0.04), significantly higher BMIL at 36 months (Z=9. 11, p<0.00001), and significantly higher costs (Z=2.87, p=0.004) in the LSG group. In addition, for the first time, complications (i.e., GERD, wound infection, port-site hernia, and mortality) and improvement of dyslipidemia were compared between the two techniques. According to our pooled data, no significant differences were found in any of the above aspects. In conclusion, LSG is superior to LGCP with regard to providing effective weight loss in the short- and mid-term. LSG has a lower rate of minor complications, but was less effective when considering cost. The two procedures are similar in terms of improvement of comorbidities, major complications, operative time, and length of stay.