Download Bariatric Surgical Procedures for Obese and Morbidly

May 2014
Bariatric Surgical Procedures for Obese and Morbidly Obese
Patients: A Review
Context
Approximately 18% of Canadian adults are obese and,
therefore, are at a higher risk for comorbid conditions
such as hypertension, dyslipidemia, type 2 diabetes,
cardiovascular disease, cancer, and osteoarthritis. Not
surprisingly, these comorbidities lead to a reduction in
life expectancy.
Technology
Found to be more effective for weight loss than
medications and lifestyle interventions, bariatric surgery
reduces the size of the stomach to limit the volume of
food a patient can consume, connects the stomach to
the small intestine so food is diverted and fewer calories
are absorbed, or both. The most common procedures
are Roux-en-Y gastric bypass, sleeve gastrectomy, and
laparoscopic adjustable gastric banding.
Issue
Each bariatric surgical procedure has benefits and risks.
A review of the comparative clinical effectiveness, safety,
and cost-effectiveness of Roux-en-Y gastric bypass,
sleeve gastrectomy, and laparoscopic adjustable gastric
banding in obese and morbidly obese patients, and of the
evidence-based guidelines, will help inform decisions on
the use of these procedures.
Methods
A limited literature search was conducted of key
resources, and titles and abstracts of the retrieved
publications were reviewed. Full-text publications were
evaluated for final article selection according to
predetermined selection criteria (population,
intervention, comparator, outcomes, and study designs).
Key Messages
 Roux-en-Y gastric bypass is more effective
for weight loss than laparoscopic adjustable
gastric banding, but has a higher risk of
complications.
 Sleeve gastrectomy appears to be
o more effective for weight loss than
laparoscopic adjustable gastric banding,
but has a higher risk of complicationsa
o less effective for weight loss than
Roux-en-Y gastric bypass, but has a lower
risk of complications.a
 Not enough information was found to
compare the cost-effectiveness of bariatric
surgical procedures.
 No guidelines recommending specific
bariatric surgical procedures were found.
aBased
on conflicting evidence.
Results
The literature search identified 468 citations, with
21 additional articles identified from other sources.
After screening the abstracts, 68 were deemed
potentially relevant and 21 met the criteria for
inclusion in this review — 1 health technology
assessment, 10 meta-analyses, 3 systematic
reviews, 5 randomized controlled trials, and
2 economic analyses.
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CADTH takes sole responsibility for the final form and content of this Report in Brief. The statements, conclusions, and views expressed herein do
not necessarily represent the view of Health Canada or any provincial or territorial government. Production of this Report in Brief is made possible
through a financial contribution from Health Canada.
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