Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding
Introduction
In 2007, at the International Federation of Surgery for Obesity (IFSO) symposium in Porto, Portugal, a summary of our systematic review and meta-analysis of worldwide Swedish Adjustable Gastric Band and Lap-Band literature was presented. The highlights of that presentation are given here, as a synopsis of the original study results (published in March 2008 in the journal of Surgery for Obesity and Related Diseases[1]), with a new Discussion, in which the findings of the current meta-analysis are considered in the context of the 3 other published bariatric surgery meta-analyses (i.e., Buchwald et al., 2004 [2]; Maggard et al., 2005 [3]; Buchwald et al., 2007 [4]).
Laparoscopic adjustable gastric banding (LAGB) is the dominant bariatric procedure outside of the United States, and its popularity is rising in America. The gastric bands available globally include the Swedish Adjustable Gastric Band ([SAGB] Obtech Medical Sarl, Le Locle, Switzerland, and Ethicon Endo-Surgery, Inc, Cincinnati, OH); Lap-Band ([LB] Allergan, Irvine, CA); AMI Band (Agency for Medical Interventions, Feldkirch, Austria); Heliogast Adjustable Gastric Ring (Hélioscopie, Vienne Cedex, France); Midband (Médical Innovation Dévelopment, Limonest, France); and the MiniMizer (HospiMedical, GmbH, Meerbusch, Germany). Meta-analysis of LAGB was undertaken to compare the 2 most used and widely studied bands available, the SAGB and LB, introduced in the mid 1980s by Hallberg and Forsell (1985) [5] and Kuzmak (1986) [6], respectively. The LAGB meta-analysis sought to assess the efficacy and safety of gastric banding as a therapeutic strategy and to compare SAGB and LB in terms of weight loss, comorbidity improvement, and adverse events (AEs). (The SAGB is available in the United States as the Realize Band).
Section snippets
Sources
On July 7, 2003, a prospective protocol was developed to undertake systematic review of the medical literature to meta-analytically compare SAGB and LB outcomes [7]. A broad electronic search was performed via PubMed accessing MEDLINE, Current Contents, and the Cochrane Library with cut-off dates of January 1, 1998 to April 30, 2006. The following search terms were employed: Obesity/surgery [MeSH] OR gastroplasty OR bariatric OR “gastric banding” with the delimitation: “Human, 1998–2006.”
Screening outcomes
Of the complete catalogue of SAGB and LB citations identified (n = 4,594), level-1 screening rejected 2,740 studies; of the remaining 1,854 studies, 1,549 were rejected in level-2 screening. Of 305 remaining studies, 176 were kin studies whose data were counted only once in amalgamation with the overlapping data of the 129 “accepted studies” (patient n = 28,980), all of which were fully extracted and eligible for meta-analysis.
Study characteristics
Accepted studies included 83 from Europe (patient n = 18,416), 22
Discussion
The above synopsis of the gastric banding meta-analysis describes the first systematic review of the world literature (4,594 citations) to encompass the cumulative studies of the 2 most commonly used LAGBs. Designs of the accepted studies were varied and ranged from several randomized controlled clinical trials to, primarily, single-center retrospective observational series. For both bands, independently, meta-analysis found significant efficacy and safety that appeared equivalent for the
Conclusion
The maturation of broadly conceived data management initiatives will, in time, provide practical solutions that greatly reduce the data summary challenges inherent in the bariatric literature. As these meta-analyses demonstrate, the literature is an enduring record that currently features the varied methods of data compilation, analysis, and reporting used since the field's inception; although many studies in this literature are methodologically strong individually, the variance in data
Disclosures
Dr. Cunneen is a consultant for Ethicon Endo-Surgery; his expenses for the symposium and an honorarium were paid by Ethicon Endo-Surgery, Inc., the manufacturer of the Realize Band (also known as the Swedish Adjustable Gastric Band).
Acknowledgment
The author acknowledges and thanks United BioSource Corporation, Medford, MA (formerly Metaworks, Inc.) for the statistical analysis performed for the original gastric banding meta-analysis.
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