Comparative effectiveness of metabolic and bariatric surgeries: a network meta-analysis

Area of Science:

• Metabolic and Bariatric Surgery
• Obesity Management
• Surgical Outcomes Research

Background:

• Unhealthy weight and obesity necessitate effective interventions.
• Bariatric surgery is a key treatment option for significant weight reduction.
• Comparing various surgical techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

• To systematically compare and rank bariatric surgical procedures based on their efficacy in reducing weight parameters.
• To provide evidence-based guidance for selecting the most effective bariatric surgery for individuals with obesity.

Main Methods:

• A comprehensive literature search was conducted across major databases (MEDLINE, Cochrane CENTRAL, Scopus, Web of Science) up to September 2023.
• A network meta-analysis was performed on data from 67 clinical trials, extracting outcomes as mean change from baseline.
• Statistical analysis used mean difference with 95% confidence intervals, employing R version 4.2.2 and RStudio version 2022.07.2.

Main Results:

• SADI-S demonstrated the greatest reduction in BMI (MD = -18.06; 95% CI [-25.31, -10.81]), followed by Duodenal-Jejunal Bypass Sleeve (DJBS).
• BPD-RYGB was most effective in reducing weight (MD = -41.48 kg), waist circumference (MD = -29.08 cm), and fat mass (MD = -31.11 kg).
• For excess weight loss (EWL), RY-DS showed the highest efficacy (MD = -61.27%), with Laparoscopic vertical banded gastroplasty (LVBG) also showing significant results.

Conclusions:

• SADI-S and BPD-RYGB emerge as highly effective bariatric procedures for specific weight parameters.
• The choice of bariatric surgery should be tailored to individual patient goals, focusing on BMI reduction, overall weight loss, or body composition changes.
• Further research may be needed to address heterogeneity observed in some pooled analyses.