RESUMEN
INTRODUCTION: Bariatric surgery is currently the gold standard treatment for obesity. The two most accomplished surgeries are the Roux-en-Y gastric bypass and the sleeve gastrectomy, and controversies exist in which is better. OBJECTIVE: To compare the two techniques in relation to weight loss with at least five years of follow-up. METHODS: Search in Medline, PubMed, Embase, SciElo, Lilacs, Cochrane databases from 2001 (beginning of vertical gastrectomy) until 2018, using the following headings: "sleeve" or "sleeve gastrectomy" combined with "gastric bypass" or "Roux-en-Y gastric bypass", "weight loss" and "clinical trial". Criteria for inclusion of articles were patients aged between 18 and 65 years; clinical trial; comparison between the two techniques; minimum five-year follow-up; outcome with weight loss assessment. RESULTS: The initial search identified 1940 articles, of which 185 publications were identified as clinical trials. One hundred and forty-one were excluded, 67 because they did not compare the two techniques, 57 not addressed weight loss and 17 were repeated articles. Thirty-four studies were retrieved for a more detailed analysis; 36 studies were excluded due to a follow-up of less than five years, and another compared the mini-gastric bypass. In total, seven studies were included in the systematic review, but there was no significant difference in three of them. CONCLUSION: The gastric bypass had a greater weight loss than the vertical gastrectomy in all the evaluated studies.
Asunto(s)
Derivación Gástrica/métodos , Gastroplastia/métodos , Obesidad Mórbida/cirugía , Pérdida de Peso , Estudios de Seguimiento , Humanos , Resultado del TratamientoRESUMEN
ABSTRACT Introduction: Bariatric surgery is currently the gold standard treatment for obesity. The two most accomplished surgeries are the Roux-en-Y gastric bypass and the sleeve gastrectomy, and controversies exist in which is better. Objective: To compare the two techniques in relation to weight loss with at least five years of follow-up. Methods: Search in Medline, PubMed, Embase, SciElo, Lilacs, Cochrane databases from 2001 (beginning of vertical gastrectomy) until 2018, using the following headings: "sleeve" or "sleeve gastrectomy" combined with "gastric bypass" or "Roux-en-Y gastric bypass", "weight loss" and "clinical trial". Criteria for inclusion of articles were patients aged between 18 and 65 years; clinical trial; comparison between the two techniques; minimum five-year follow-up; outcome with weight loss assessment. Results: The initial search identified 1940 articles, of which 185 publications were identified as clinical trials. One hundred and forty-one were excluded, 67 because they did not compare the two techniques, 57 not addressed weight loss and 17 were repeated articles. Thirty-four studies were retrieved for a more detailed analysis; 36 studies were excluded due to a follow-up of less than five years, and another compared the mini-gastric bypass. In total, seven studies were included in the systematic review, but there was no significant difference in three of them. Conclusion: The gastric bypass had a greater weight loss than the vertical gastrectomy in all the evaluated studies.
RESUMO Introdução: A cirurgia bariátrica é atualmente o tratamento padrão-ouro para o tratamento da obesidade não passível de controle clínico. As duas operações mais feitas são o bypass gástrico em Y-de-Roux e a gastrectomia vertical, e por isso tem sido foco de muita discussão. Objetivo: Comparar as duas técnicas em relação à perda de peso com pelo menos cinco anos de acompanhamento. Métodos: As buscas dos trabalhos foram realizadas nas bases de dados eletrônicas Medline, PubMed, Embase, SciElo, Lilacs, Cochrane de 2001 (início da gastrectomia vertical) até 2018, usando os seguintes descritores: "sleeve" ou "sleeve gastrectomy" combinada com "gastric bypass" ou "Roux-en-Y gastric bypass","weight loss" e "clinical trial". Critérios de inclusão foram: trabalhos com pacientes com idade entre 18 e 65 anos; ensaio clínico; comparação entre as duas técnicas; acompanhamento mínimo de cinco anos; desfecho com avaliação de perda de peso. Resultados: A busca inicial identificou 1940 artigos, destes 185 publicações foram identificadas como ensaios clínicos. Cento e quarenta e um foram excluídos devido a que 67 não compararem as duas técnicas, 57 não abordaram a perda de peso e 17 por serem artigos repetidos. Foram recuperados 44 estudos para uma análise mais detalhada, 36 deles foram excluídos devido ao seguimento menor que cinco anos e outro por comparar o minibypass gástrico. No total sete estudos foram incluídos na revisão sistemática; no entanto, não houve diferença estatisticamente significativa em três deles. Conclusão: O bypass gástrico teve perda de peso maior que a gastrectomia vertical em todos os trabalhos avaliados.