Comparison of different revisional surgeries after sleeve gastrectomy: A network meta-analysis

IntroductionSleeve gastrectomy (SG) is the most commonly performed bariatric surgery worldwide. Despite its effectiveness, over 20% of patients require revisional surgery due to weight regain, insufficient weight loss, or complications such as gastroesophageal reflux disease (GERD). Various revisional bariatric procedures are available. This study aims to systematically compare the efficacy and safety of these revisional procedures following failed SG. MethodsThis systematic review and network meta-analysis (NMA) adhered to PRISMA guidelines. A comprehensive literature search was conducted until May 2024. Studies comparing at least two bariatric surgeries for revisions after SG were included. Data on total weight loss percentage (%TWL), excess weight loss percentage (%EWL), and morbidity rates were extracted. Bayesian NMA was performed using the "gemtc" package in R software. Outcomes were assessed using mean differences (MD) and odds ratios (OR) with 95% credible intervals (CrI). ResultsTwenty-three studies involving 3266 participants were included. In %EWL, SADI-S (MD 14.80; 95% CrI: 5.38, 24.40) and OAGB (MD 8.28; 95% CrI: 1.99, 14.30) were significantly more effective. In %TWL, SADI-S (MD 9.27; 95% CrI: 1.06, 17.8) showed superior outcomes. No significant differences in morbidity rates were observed among the revisions. SUCRA analysis ranked SADI-S highest for both %EWL and %TWL, and re-LSG as the best choice in regards to morbidity. ConclusionSingle anastomosis duodeno-ileal bypass with sleeve (SADI-S) is the preferred revisional procedure following sleeve gastrectomy due to superior weight loss outcomes and comparable complication rates. Further randomized controlled trials are needed to confirm these findings.