Bariatric treatments for adult obesity - Institute of Health Economics

Results from two trials with 100 patients did not reveal any significant difference in incidence ofpost-operative readmission between RYGB and AGB groups.Reoperations and revisionsTwo trials with 248 patients found that, when compared with the RYGB group, the AGB group hadmore late failed surgeries (conversions and reversals); however, no significant differences wererevealed in rates of early/late reoperation and reversals between the RYGB and the AGB group.Comparing open to laparoscopic RYGB and VBG, four trials with 286 patients found no significantdifference in incidence of early reoperation and three trials with 233 patients found no significantdifference in incidence of late reoperation.One trial with 69 patients did not find any significant difference in incidence of late reversal betweenopen and laparoscopic AGB.Gastrointestinal disturbancesSixteen trials reported incidences of dumping syndrome, dyspepsia, dysphagia, gastritis, reflux, ulcer,or vomiting. There were significantly fewer late ulcers in the AGB group than in the RYGB group.No direct comparisons for other AEs were available for AGB, RYGB, or sleeve gastrectomy.Five clinical trials involving 556 patients reported the incidence of reflux, ulcer, or vomiting. Thepatients with open surgeries experienced significantly less vomiting. No other results weresignificantly different in comparing laparoscopic and open surgeries.Surgical complicationsCompared to RYGB groups, AGB groups had a significantly lower risk of early wound infection,late stenosis, and late hernia, but a significantly higher risk of late slippage or dilatation. No trialsreported the comparative incidence of myocardial infarction.Eight trials involving 694 patients reported the incidence of anastomotic leak, bowel obstruction,hernia, respiratory failure, staple-line breakdown, luminal stenosis, wound infection, or venousthromboembolic disease. Compared to open surgeries, laparoscopic surgeries were associated withsignificantly fewer incidents of early wound infection and late hernias, but significantly higherincidents of late luminal stenosis.In summary, compared to RYGB patients, AGB patients had significantly shorter hospital stays anda lower risk of early wound infection, late ulcers, late stenosis, and late hernia, but had a higher riskof late slippage or dilatation and late failed surgeries (conversions and reversals).Compared to open surgery patients, those who received laparoscopic surgery had significantlyshorter hospital stays and fewer incidents of early wound infection and late hernias, but hadsignificantly higher incidents of late luminal stenosis and experienced more vomiting. No differenceswere observed in reoperation and revision rates between laparoscopic and open surgeries.No trials reported the comparative incidence of myocardial infarction following bariatric surgeries.Neither the incidence rates of the above-noted AEs nor the timeframe for their occurrence werereported in this review.Bariatric treatments for adult obesity 79