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Systematic review of MGB

Review finds MGB is safe and effective

LMGB could be performed successfully and few needed conversion to open surgery
LMGB was efficient in reducing body weight and improving T2DM with nearly all patients achieved %EWL higher than 60% at one year after surgery

Laparoscopic mini gastric bypass (LMGB) is at least not inferior to laparoscopic gastric bypass (LRYGB), laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in terms of weight loss and type 2 diabetes (T2DM) remission and has few complications. These are the conclusions from a met-analysis by researchers from Fudan University Pudong Medical Center, Shanghai, China, who state that future clinical trials are still needed to demonstrate its utility and establish the guidelines for LMGB.

The paper, ‘Efficacy of Laparoscopic Mini Gastric Bypass for Obesity and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis,’ published in the journal Gastroenterology Research and Practice, is a systematic review and meta-analysis that evaluates and compares the efficacy, advantages and complications of LMGB with those of LAGB, LSG, and LRYGB, and reports the evidence to support the use of LMGB in treating obesity and T2DM.

The researchers conducted the literature search that identified 31 articles: 16 non-controlled single-arm case studies reported the surgical outcomes of LMGB, eight studies compared LMGB with LAGB, six studies compared LMGB with LSG and five studies compared LMGB with LRYGB; they were included in the meta-analyses, respectively. Overall, 16 studies reported the outcomes of LMGB for obese patients with participants ranging from 10 to 2,410. Female patients were predominant and mean BMI>35 in most studies. The percentages of patients with T2DM varied from 0 to 100%.

They found that in all the studies, LMGB could be performed successfully and few needed conversion to open surgery. The postoperative results of LMGB were recorded at different time points, ranging from three months to six years, and different parameters of surgical outcomes were used, including %EWL, ΔBMI, weight loss, postoperative BMI and weight, change in glucose, HbA1c (glycosylated hemoglobin), and remission of T2DM. LMGB was efficient in reducing body weight and improving T2DM. Nearly all patients achieved %EWL higher than 60% at one year after surgery. Regarding the long-term weight control effects, LMGB was also effective.

They also reported that LMGB significantly improved T2DM: of the nine studies which reported T2DM status, seven studies achieved T2DM remission or improvement rate more than 80%.

LMGB and LAGB

Though LMGB showed a marginally higher T2DM remission rate than LAGB, only two studies included made this comparison less credible. Similarly, LMGB achieved lower BMI and reduced WC than LAGB; however, preoperative demographics varied among studies and in that case changes in BMI and WC would be more accurate in measuring weight loss than postoperative BMI and WC. The meta-analysis results were presented in Figure 1.

Figure 1: Meta-analysis comparing LMGB with LAGB. (a) Remission rate of T2DM. (b) Postoperative BMI. (c) Postoperative waist circumference. The estimates of the weighted risk ratio/mean difference in each study corresponded to the middle of each square and the horizontal line gave the 95% CI. The summary risk ratio/mean difference was represented by the middle of the solid diamond.

LMGB and LSG

In total, six studies reported either short- or long-term outcomes of LMGB and LSG. Remission of T2DM was better in patients receiving LMGB: meta-analysis of four studies showed higher remission rate of LMGB (89% versus 76%, p=0.004) and no heterogeneity was observed (%) (Figure 2). LMGB seemed to have lower revision rate than LSG (1.6% versus 14.1%, p=0.004). Other parameters such as 1-year %EWL and 1-year postoperative BMI did not show significant differences between the two surgical approaches.

Figure 2: Meta-analysis comparing LMGB with LSG. (a) 1-year postoperative %EWL. (b) Overall remission rate of T2DM. (c) Revision surgery rate. (d) 1-year postoperative BMI

LMGB and LRYGB

Five studies compared the outcomes of LMGB and LRYGB. Compared with LRYGB, LMGB seemed more effective in weight loss (%EWL, p=0.0008) and remission of T2DM (93.4% versus 77.6%, p=0.006) than LRYGB (Figure 3).

Figure 3: Meta-analysis comparing LMGB with LRYGB. (a) Operation time. (b) 1-year postoperative %EWL. (c) Overall remission rate of T2DM

Proponents of LMGB believed that one less anastomosis than LRYGB made it much easier to learn and perform…The late complications including bile reflux, marginal ulcer, and iron deficiency anaemia should be noted…However, remnant gastric cancer caused by bile reflux was rarely reported and reconstruction with Roux-en-Y gastric bypass proved to be quite safe,” they note.

“Inconformity in definition of T2DM remission made the meta-analyses only include limited studies, making the result less credible,” the authors conclude. “Though the weight control and metabolic effects of bariatric surgeries had been well established, it remained controversial which technique should be given priority for obese patients…Additionally, for patients who failed sleeve gastrectomy, conversion to LMGB was found to be feasible, safe, and effective. Thus, further trials to comprehensively evaluate the treatment choices of bariatric procedures are needed.”

To access this paper, please click here

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