Long-term follow-up after bariatric surgery: a systematic review

Area of Science:

• Bariatric surgery
• Obesity management
• Metabolic disease treatment

Background:

• Bariatric surgery is a recognized treatment for obesity, yet long-term follow-up data with high retention rates are scarce.
• Assessing the long-term effectiveness of different bariatric procedures is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the quality of evidence and treatment effectiveness of bariatric surgery at two years post-procedure.
• To compare outcomes for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults.

Main Methods:

• A systematic review of MEDLINE and Cochrane databases was conducted, searching for studies published from 1946 to May 2014.
• Included studies focused on gastric bypass, gastric band, or sleeve gastrectomy in patients with a body mass index ≥35, with over two years of outcome data and ≥80% patient follow-up.
• Data extraction and study inclusion were performed by two independent investigators.

Main Results:

• Out of 7371 studies, only 29 met the inclusion criteria, involving 7971 patients.
• Gastric bypass and sleeve gastrectomy demonstrated excess weight loss exceeding 50% in all analyzed studies, while gastric band achieved this in only 31%.
• Gastric bypass yielded significantly higher excess weight loss (65.7%) compared to gastric band (45.0%). Remission rates for type 2 diabetes, hypertension, and hyperlipidemia were substantially higher following gastric bypass than gastric band.

Conclusions:

• Few bariatric surgery studies provide robust long-term follow-up data, potentially introducing bias.
• Gastric bypass offers superior outcomes for weight loss and comorbidity remission compared to gastric banding.
• Evidence regarding the long-term efficacy of sleeve gastrectomy remains insufficient.