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Banded versus non-banded sleeve gastrectomy in obese patients: A systematic review & meta-analysis

      Highlights

      • Both SG and BSG is effective at reducing EWL within the first year of surgery.
      • After the first year of surgery, BSG is superior to SG with continued EWL over time.
      • There is no difference in overall complications following both procedures.

      Abstract

      Background & aims

      Weight regain represents an important issue after sleeve gastrectomy (SG), hence banded sleeve gastrectomy (BSG) was proposed. Aim of this meta-analysis was to compare the performance ofBSG versus SG in obese patients.

      Methods

      We searched the PubMed/Medline and Embase database through October 2020 and identified 6 studies, of which 2 randomized-controlled trials (recruiting673 patients). The primary outcome was % excess weight loss (%EWL); secondary outcomes included % total weight loss (%TWL), HbA1c improvement, overall complication and major complication rate, gastro-esophageal reflux disease (GERD)occurrence. We performed pairwise meta-analysis through a random effects model and expressed data as standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (CI).

      Results

      A sharp decline in %EWL at 1 year was observed with both treatments with no significant difference (SMD 5.99, −1.17 to 13.16), whereas a clear benefit with BSG over SG was observed over time (SMD 15.95, 13.31 to 18.58 at 2 years; 18.37, 13.31 to 23.42 at 3 years; 24.75, 22.38 to 27.12 at 4 years; 29.85, 27.22 to 32.49 at 5 years). Meta-regression did not find any significant correlations between age, sex, and baseline BMI with %EWL. Similarly, no difference in terms of %TWL was observed at 1 year (SMD 1, -3.31 to 5.30), whereas the magnitude of the benefit with BSG increased significantly from the second year onwards (SMD 5.99, 3.7 to 8.27 at 2 year, 6.86, 5.13 to 8.59 at 3 year, and 9.36, 7.07 to 11.65 at 5 year). No difference in terms of HbA1c improvement was observed (SMD 0.40, −0.64 to 1.43). No difference in overall complication (OR 1.44, 0.55–3.76), major complications (OR 1.14, 0.52–1.87), and incidence of GERD was observed (OR 1.06, 0.56–2).

      Conclusion

      BSG is superior to SG in obese patients, due to its ability to significantly increase %EWL with no additional safety issues.

      Keywords

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