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REVIEW ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 3  |  Page : 97-100

Systematic review of successful rate of body weight loss after bariatric surgery


Department of Clinical Affairs, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Date of Web Publication6-Nov-2017

Correspondence Address:
Odai Mohammed Albahli
King Abdulaziz Medical City, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ssj.ssj_74_16

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  Abstract 

Background: Bariatric surgery is an accepted treatment for obesity. And, only a limited number of studies were concerned with the outcome of significant weight loss following the surgery procedures.
Objective: the aim of this systematic review was to evaluate and demonstrate the comprehensive data about the significant loss of body weight of obese patients after appropriate techniques of different bariatric surgery procedures and to determine the impact of bariatric surgery on weight loss.
Methodology: MEDLINE and Cochrane databases were searched from 1989 to July 15, 2016. Search terms included bariatric surgery, individual bariatric procedures, and obesity significant body weight loss. Studies were included if they described outcomes of interest, which were significant body weight loss after gastric bypass, gastric band, or sleeve gastrectomy performed on obese patients.
Conclusion: Significant body weight loss was achieved in most of the obese patients after undergoing bariatric surgery; most of the studies that were included in this review showed that all current bariatric operations lead to major weight loss.

Keywords: Bariatric, bypass, gastrectomy, surgery


How to cite this article:
Albahli OM, Alharbi M, Albahli Y, Alotaibi S. Systematic review of successful rate of body weight loss after bariatric surgery. Saudi Surg J 2017;5:97-100

How to cite this URL:
Albahli OM, Alharbi M, Albahli Y, Alotaibi S. Systematic review of successful rate of body weight loss after bariatric surgery. Saudi Surg J [serial online] 2017 [cited 2017 Dec 15];5:97-100. Available from: http://www.saudisurgj.org/text.asp?2017/5/3/97/217749




  Introduction Top


Obesity has reached epidemic proportions in society recently; according to the World Health Organization, the prevalence of overweight and obesity is increasing globally, and in 2010, there were 500 million people worldwide who met the criteria for obesity.[1],[2] Furthermore, it is connected with high rates of mortality because of the incidents of serious comorbidities, a significant number of which show complete determination after weight reduction.[3] In addition, bariatric surgery results in extensive, maintained weight reduction in extremely obese populations. Although for the most part acknowledged as the best means for inciting weight loss in very heavy patients, as known Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy (SG) are two major types of bariatric surgery procedures that cause significant weight loss in adults and are increasingly being performed in adolescents with morbid obesity following by gastric band.[4] Few studies exist reporting outcomes longer than 2 years after the surgery was performed. Long-term outcome studies that exists are mostly case series, from limited geographical areas, or report surgical procedures no longer performed.[5],[6],[7],[8],[9]

To recent event, viable long-term weight reduction through pharmacological treatment has been minor, leaving bariatric surgery as the main reported medicinal intercession giving significant, long-effective weight reduction for most patients who are seriously overweight.[10] For those high-risk individuals, the quantities of studies reporting long-period weight reduction follow-up taking after bariatric surgery are limited and generally have incomplete follow-up.[11]

Several studies [5],[12],[13],[14] have shown bariatric surgery as a successful long-term treatment for weight reduction for people with extreme (Class III) obesity, especially when measured 2 years postoperatively.

Objectives

The purpose of this systematic review was to evaluate and demonstrate the comprehensive data about the significant loss of body weight of obese patients after appropriate techniques of different bariatric surgery procedures and to determine the impact of bariatric surgery on weight loss.


  Methodology Top


Study design

A systematic review study was conducted and reported according to the review guidelines.[15]

Data sources and searches

Comprehensive searches of the literature were performed on MEDLINE, Embase, Scopus, Cochrane, and Clinical Trials from 1989 to July 15, 2016. The search was done by combination of (mesh) medical terms as following: “bariatric surgeries,” “gastric bypass,” “roux-en-y gastric bypass,” and “body weight loss, obesity, overweight.”

Search results were screened by scanning abstracts for the following exclusion criteria: publication of abstracts only, case reports, letters, comments, animal studies; languages other than English; duplicate studies; no surgical intervention; and lack of outcomes of interest (weight change). After removing excluded abstracts, full articles were obtained and studies were screened again more thoroughly using the same exclusion criteria.


  Results Top


We identified 451 references and clinical studies between randomized clinical trial (RCT), Cohort studies, and systematic reviews. Part of these studies were excluded after reviewing titles, abstracts, and the complete journal articles and that because they did not discuss the outcomes of interest which is body weight loss. Twenty-six clinical studies [4],[6],[7],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36] were included in the results and discussions of this review to evaluate the significant body weight loss; other studies were included in the background of this study to have evidence-based support for our study.

Twenty-four studies [4],[6],[7],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36] reported outcome of interest which is weight loss outcomes. Most studies expressed mean weight loss (% EWL) (20/24 studies), followed by change in BMI (16/24) and change in absolute weight (11/24), of these 16 studies included sufficient information (mean %EWL or mean percentage of absolute weight loss and standard deviation) to calculate 95% confidence intervals. We demonstrated some of the study results [Figure 1].[25]
Figure 1: Frequency distribution of percentage weight change from baseline to 2-year and 6-year follow-up examinations

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Out of these 24 studies, 11 studies were gastric bypass [4],[6],[16],[17],[18],[24],[25],[29],[30],[31],[32] (n = 3544 patients), 13 studies gastric band [19],[20],[21],[22],[23],[25],[26],[27],[28] (n = 4109 patients), and two SG (n = 115 patients).[35],[36] Approximately half of the studies had follow-up time exceeding 3 years.[4]

As the diagram demonstrating its shows that the percentages of participants in the gastric bypass surgery group are shown grouped by 5% of unadjusted baseline weight loss intervals at the 2-year and 6-year follow-up examinations.[25]

Gastric bypass resulted in greater weight loss than the gastric band. All gastric bypass (11/11) and SG (2/2) cohorts had 95% confidence intervals of the reported mean or median exceeding 50% excess weight loss. This only occurred in 31% (4/13) of gastric band cohorts. The sample-size-weighted mean excess weight loss was 65.7% after gastric bypass (n = 3544 patients, 6/11 prospective cohorts) compared to 45.0% after gastric band (n = 4109 patients, 9/13 prospective cohorts). The sample-size-weighted mean excess weight loss after SG was 64.5% (n = 115 patients, 2/2 retrospective cohorts). The sample-size-weighted mean EWL between 2 years and 3 years or longer after surgery was significant within both gastric bypass (68.4% vs. 64.5%; P < 0.001) and gastric band (49.4% vs. 41.8%; P < 0.001). Gastric band studies reporting more than 50% excess weight loss by median, means, and 95% confidence intervals included two RCTs.[21],[22]

Moreover, one study [4] was identified through our research which showed that after 3 years of following RYGB or laparoscopic adjustable gastric banding (LAGB), they assessed percentage weight change from baseline and the percentage of patients with without pharmacologic therapy [Figure 2].
Figure 2: (a) percent of weight change with Roux-en-Y Gastric Bypass. (b) percent of weight. With Laproscopic Adjustable Gastric Band

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The 5 RYGB trajectories all show initial weight loss within the first 6 months after surgery [Figure 2]a. After 6 months, on average, the participants in Group 1 (2%) begin to regain weight while those in Groups 3, 4, and 5 continue to lose weight through 2 years. After 2-year follow-up, the trajectories for Groups 2, 3, 4, and 5 begin to demonstrate some weight regain. However, in 76% of the RYGB participants represented (Groups 3–5), the weight regain is small compared to the overall loss.

[Figure 2]b shows 5 weight change trajectory groups for those who underwent LAGB. Almost two-thirds (62%) of the participants are included in Group 2 which shows the greatest average weight loss occurring in the first 6 months then a slowing of weight loss and stabilization after 2 years. LAGB participants in Group 1, the second most common trajectory (19%), experienced weight loss, on average, only during the first 6 months of follow-up, gaining weight, on average through year 3. The Group 5 trajectory (4%) shows continual weight loss throughout the 3-year period while Group 3 (14%) shows steady weight loss for the first 2 years and then slight weight regain from years 3 to 3. Group 4 includes only seven participants who experienced substantial weight loss through year two with an increase in weight afterward.


  Conclusion Top


It was observed through this review that the bariatric surgery provides successful and sustained effects on weight loss and ameliorates obesity-attributable comorbidities in the majority of bariatric patients. Although risks of complication, reoperation, and death exist, still significant body weight loss was achieved in most of obese patients after undergoing bariatric surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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  [Figure 1], [Figure 2]



 

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