Davis Waller1, Angel Farinas, MD2, Christian Cruz Pico, MD2, Angelina Postoev, MD2, Christopher Ibikunle, MD2, Aliu Sanni, MD2. 1MCG/UGA Medical Partnership, 2Georgia Surgicare
Among patients undergoing bariatric surgery, the superobese patients (BMI>50) are considered more challenging with higher morbidity and mortality. Few studies have been published regarding perioperative outcomes of bariatric surgery in this particular patient group, and even fewer studies offer a direct comparison of clinical outcomes between the traditional laparoscopic roux-en-y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Considering the increasing use of LSG in this patient population, a meta-analysis of the existing comparative data is useful for determining the appropriate procedural choice.
A systematic review was conducted to identify relevant studies from PubMed from 2010-2015 with comparative data on perioperative outcomes of LRYGB versus LSG in patients with BMI>50. The primary outcomes were percentage excess weight loss (%EWL) at 12 months, operative time, length of stay, perioperative complications, and mortality. Results are expressed as standard difference in means with standard error. Statistical analysis was done using random-effects meta-analysis to compare the mean value of the two groups (Comprehensive Meta Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).
Four retrospective studies were quantitatively assessed and included for meta-analysis. Among the four studies, 238 were LSG patients and 422 were LRYGB patients. LSG results in a significantly lower %EWL (-0.576±0.234, p=0.01) and decreased operative time (-0.590±0.176, p=0.02) when compared to LRYGB. There were no difference in the length of stay (-0.206±0.211, p=0.055), rate of complications (0.056±0.21, p=0.599), or mortality (-0.002±0.255, p=0.990) when comparing these two procedures.
LSG is safe in the superobese patients as it presents similar outcomes to LRYGB. The %EWL seen at 12 months is increased in the LRYGB group.