Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en- Y Gastric Bypass (LRYGB) may have better health-related quality of life (HRQoL) across most follow-up time points, and long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions, according to a meta-analysis by a team of international researchers. The findings were reported in the paper, ‘Quality of Life After Bariatric Surgery—a Systematic Review with Bayesian Network Meta-analysis, published in Obesity Surgery.
The study group, led by researchers from Poland, stated that although weight loss and comorbidities remission are important outcomes from metabolic surgery, improvements in health-related quality of life (HRQoL) is an important, if not, under-reported outcome. Therefore, they conducted a comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis. They believe their network meta-analysis is the first to attempt to summarise and compare HRQoL after different bariatric procedures in patients with severe obesity.
The primary outcome of the study was HRQoL at one year, two years, three years and five years after bariatric surgery, and secondary outcomes involved specific domains of HRQoL (vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health).
In total, the researchers included 47 studies (17 RCTs and 30 non-RCTs) encompassing 26,629 patients and 11 different surgical techniques in their analysis (LSG, 25 studies, LRYGB, 37 studies, laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS, 6 studies), laparoscopic vertical banded gastroplasty (VBG, 1 study), laparoscopic adjustable gastric banding (LAGB, 8 studies), laparoscopic banded Roux-en-Y gastric bypass (banded-GB, 2 studies), laparoscopic greater curvature plication (LGCP, 1 study), laparoscopic distal Roux-en-Y gastric bypass (distal-GB, 2 studies), laparoscopic one anastomosis gastric bypass (OAGB, 5 studies), prolonged biliopancreatic limb gastric bypass (LB-GB, 1 study), and distal one anastomosis gastric bypass (distal-OAGB, 1 study).
At one year, there was a significant difference in HRQoL favouring of LSG, LRYGB and OAGB compared with lifestyle intervention, and no significant effect for the remaining procedures. In a comparison of LRYGB and LSG, they found a significant difference in HRQoL in favour of LRYGB, while VBG, LAGB and distal-OAGB had significantly lower HRQoL than LSG and LRYGB. In addition, LAGB was inferior to lifestyle intervention in physical domain and general health perceptions domain of HRQoL, while LSG, LRYGB, BPD-DS and OAGB were associated with better HRQoL in general health perception domain than control.
At two years, banded-GB and LB-GB had significantly better HRQoL, compared with lifestyle intervention. In a comparison of LRYGB and LSG, the former was associated with better HRQoL than LSG, however, it was not clinically relevant. Compared to standard LRYGB, distal-GB was associated with worse HRQoL however, LB-GB and banded-GB modifications were associated with better HRQoL. Furthermore, LAGB was associated with worse HRQoL vs LSG, LRYGB, BPD-DS, banded-GB, and LB-GB.
At three years, LSG, LRYGB, BPD-DS and LAGB all had better HRQoL vs. lifestyle intervention, while no significant differences were found for the remaining procedure in comparison with control.
Finally, at five years LSG, LRYGB, BPD-DS and OAGB had better HRQoL in comparison to control. Comparisons revealed LRYGB and BPD-DS had better HRQoL than LSG and OAGB, with no difference between LRYGB and BPD-DS.
In summary, the authors noted:
At one year, LSG, LRYGB and OAGB offer better QoL in comparison to non-surgical interventions, with LRYGB showing better results than LSG
At two years, patients who received banded-GB reported better HRQoL improvement than non-surgical patients, while LAGB resulted in worse results than other techniques, excluding OAGB and distal-GB
At three and five years, LRYGB and LSG maintained HRQoL after surgery. BPD-DS at five years showed significant improvement to control, which contrasts with previous years
“Our analysis indicates that some procedures such as VBG or LAGB may lead to worse HRQoL,” the authors concluded. “Future studies comparing different types of bariatric procedures should include HRQoL-related measures to their list of outcomes besides weight loss, comorbidities, and complications to provide a holistic perspective of each procedure.”
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