Table 3.
Summary of Findings: Best Evidence on Comparative Effectiveness of Different Types of Bariatric Surgery in Super Obese (BMI ≥ 50 kg/m2) Patients at < 5 Years
| Comparison | Number and type of studies, sample sizes, endpoint | %EWL | Mortality | Complications | Diabetes remission |
|---|---|---|---|---|---|
| DS vs. LRYGB | Short-term: 6 primarily US retrospective cohorts31 , 36 , 38 – 40 , 48 N = 27,645 | ★ | ★ | ★ | ★ |
| LRYGB vs. LAGB | 1 US, single-center, retrospective cohort in Brooklyn31 N = 106, 16 months | 52% vs. 31%, P < 0.001 ★★ |
No deaths ★★ |
Early complications: 17% vs. 18%, P = 0.33 ★★ Late complications: 28% vs. 78%, P < 0.05 ★★ |
NR |
| LRYGB vs. LSG | 2 non-US, single-center retrospective cohorts in Mexico and France46 , 48 N = 436, 12 months | 55–63.9% vs. 40.2–43.9%, P < 0.05 ★★ |
30 days: 1% vs. 0%, P = 0.9946
12 months: No deaths48 ★★ |
<30 days: Complications: 9% vs. 22%, P > 0.248 Major adverse events*: ★★ 5.7% vs. 6.7%, P = 0.8546 |
Resolution: 70.7% vs. 47.5%, P = 0.01 ★★ |
| LRYGB vs. LSG in super super obese (BMI ≥ 60 kg/m2) | 1 US single-center retrospective cohort in New York44 N = 135, 37 months | ★ | NR | NR | NR |
| Banded vs. non-banded LRYGB | 1 US, single-center retrospective cohort in Ohio34 N = 189, 2 years | 57.5% vs. 47.6%, P = 0.003 ★★ |
NR | NR | NR |
| Laparoscopic vs. open gastric bypass | 1 US, subgroup analysis from a single-center retrospective cohort in Tennessee43 N = unknown for super obese subgroup | ★ | NR | NR | NR |
| Laparoscopic vs. open gastric bypass in mega obese (BMI > 70 kg/m2) | 1 US, single-center retrospective cohort in Ohio42 N = 89, 2 years | 3 months: 22.7% vs. 17.5, P = 0.016 6 months: 37.6% vs. 30.8%, P = 0.037 1 year: 48% vs. 48% 2 year: 60% vs. 60% ★★ |
0 vs. 2% ★★ |
Hernia: 19% vs. 3%; P = 0.02 ★★ No differences in other complications ★★ |
NR |
| Proximal vs. distal RYGB | 1 non-US, double-blind RCT with two participating centers in Norway30 N = 113, 2 years | NR | No deaths ★★ |
Severe complications: 0% vs. 10.7%; P = 0.01 ★★ Reoperations: 0% vs. 10.7% ★★ No significant differences in other complications ★★ |
NR |
Note: Strength of evidence: ★★★★ = High; ★★★ = Moderate; ★★ = Low; ★ = Insufficient
*Major adverse events: death, percutaneous or endoscopic interventions or repeat surgery, venous thromboembolism (VTE) and failure to be discharged from the hospital
Abbreviations: aHR = adjusted hazard ratio, DS = duodenal switch, LAGB = laparoscopic adjustable gastric banding, LRYGB = laparoscopic Roux-en-Y gastric bypass, LSG = laparoscopic sleeve gastrectomy, NR = not reported, RYGB Roux-en-Y gastric bypass, %EWL = % excess weight loss