Summary of findings 3. Laparoscopic Roux‐en‐Y gastric bypass compared with laparoscopic sleeve gastrectomy for obesity.
| Laparoscopic gastric bypass compared with laparoscopic sleeve gastrectomy for obesity | ||||||
| Patient or population: participants with obesity Settings: any Intervention: laparoscopic gastric bypass Comparison: laparoscopic sleeve gastrectomy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Laparoscopic sleeve gastrectomy | Laparoscopic Roux‐en‐Y gastric bypass | |||||
| BMI at study end [kg/m²] Follow‐up: 12 to 36 months | The mean BMI at study end ranged across control groups from 27 to 33 | The mean BMI at study end in the intervention groups was 0.2 lower (1.8 lower to 1.3 higher) | ‐ | 353 (6) | ⊕⊕⊝⊝ lowa | ‐ |
| Health‐related quality of life Follow‐up: mean 12 months | See comment | See comment | ‐ | 217 (1) | ⊕⊝⊝⊝ very lowb | Interim analysis showed no statistically significant differences between groups |
| Comorbidities: diabetes [different definitions used] Follow‐up: 12 to 36 months | See comment | See comment | Not estimable | 353 (6) | ⊕⊕⊝⊝ lowc | Diabetes was reported in different ways by the studies but no relevant difference between groups was found |
|
Mortality Follow‐up: 12 to 36 months |
See comment | See comment | Not estimable | 600 (6) |
⊕⊕⊕⊝ moderated | 6 studies reported data: 1 death was observed in the laparoscopic Roux‐en‐Y gastric bypass group |
|
Serious adverse events (SAEs) [%] Follow‐up: 12 months |
See comment | See comment | Not estimable | 217 (1) |
⊕⊝⊝⊝ very lowe | 1 study reported data: 4.5% in the laparoscopic gastric bypass group and 0.9% in the laparoscopic sleeve gastrectomy group |
|
Reoperations [%] Follow‐up: 12 months |
See comment | See comment | Not estimable | 277 (2) |
⊕⊝⊝⊝ very lowe | 2 of 6 studies reported data: 6.7% to 23.6% in the laparoscopic gastric bypass group and 3.3% to 33.6% in the laparoscopic sleeve gastrectomy group |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BMI: body mass index; CI: confidence interval | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aDowngraded by two levels because of inconsistency, imprecision and some trials showing attrition bias bDowngraded by three levels because one trial only with few participants and high risk of performance, detection and 'other' risk of bias cDowngraded by two levels because of few patients and few events, and some studies showing high risk of attrition, performance, detection and selective reporting bias dDowngraded by one level because only 6 of 8 studies provided data eDowngraded by three levels because of inconsistent reporting, risk of bias and imprecision