Bypass Gástrico Roux-en-Y vs Sleeve Gástrico na Super Obesidade: Revisão Sistemática e Meta-análise

Abstract

Introduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) may present sub-optimal results in super obesity (SO) when compared with milder forms of the disease. However, they can also be safer than more complex procedures, and, therefore, the choice of the best bariatric technique in this subgroup of patients is debatable. This study aimed to summarize and critically appraise the available evidence on weight loss and resolution of comorbidities of LRYGB and LSG in super obese patients (BMI ≥ 50Kg/m2). Methods: A meta-analysis was performed by systematically identifying comparative studies conducted until the end of October 2020. The primary endpoint was weight loss outcomes after LRYGB versus LSG and the secondary endpoint was improvement or resolution of co-morbidities following these techniques in SO. Results: Sixteen studies comprising 53858 patients were included in the qualitative synthesis, from which 7 were integrated in the meta-analysis. Follow-up ranged from 6 to 72 months. The pooled result for weight loss outcomes showed a significant difference after a 6 to 12-month weight loss in favor of LRYGB, but not after 24 months. Our study demonstrated no significant difference for resolution of comorbidities except for dyslipidemia at 12 months, in which LRYGB had significant better results. Conclusion: When compared with LSG, LRYGB achieved better outcomes regarding weight loss after 6 and 12 months and dyslipidemia resolution after 1 year. There were no significant differences between procedures for resolution of the other co-morbidities studied.