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Roux-en-Y gastric bypass: systematic review and Bayesian network meta-analysis comparing open, laparoscopic, and robotic approach

Highlights•The Roux-en-Y gastric bypass (RYGB) is one of the most commonly worldwide performed bariatric procedures via open, laparoscopic, and robotic approach.•Literature evidence is based on pairwise comparison while a global and comprehensive analysis including all the three major surgical approaches is lacking.•Based on the present network meta-analysis minimally invasive LapRYGB and RoRYGB appear to be safer compared to OpenRYGB with regard to 30-day mortality, overall, infectious, and pulmonary complications.•The surgical management of morbid obesity through RYGB is evolving and the adoption of innovative minimally invasive techniques may finally improve patient outcomes.AbstractBackgroundThe Roux-en-Y gastric bypass (RYGB) is performed via Open (OpenRYGB), laparoscopic (LapRYGB), or Robotic (RoRYGB) approach. Previous review evidence is limited to pairwise meta-analysis and RoRYGB vs. OpenRYGB comparison is lacking. The aim of this network meta-analysis was to globally compare short-term outcomes within these three major surgical approaches to RYGB.Material and methodsPubMed, EMBASE, and Web of Science were consulted. A fully Bayesian network meta-analysis was performed to compare OpenRYGB, LapRYGB, and RoRYGB.ResultNineteen studies for a total of 276.732 patients were included. Overall, 28.8% underwent OpenRYGB, 67.3% LapRYGB, and 3.9% RoRYGB. The 30-day mortality was significantly lower in both LapRYGB and RoRYGB vs. OpenRYGB (RR=0.64; 95%CrI 0.46–0.97 and RR=0.49; 95%CrI 0.24-0.99, respectively). The overall complication rate was significantly lower in both LapRYGB and RoRYGB vs. OpenRYGB (RR=0.63; 95%CrI 0.42–0.91 and RR=0.60; 95%CrI 0.33-0.95, respectively). Anastomotic leak rate was similar in LapRYGB and RoRYGB vs. OpenRYGB (RR=1.10; 95%CrI 0.67–1.81 and RR=0.95; 95%CrI 0.45-2.12, respectively). Surgical Site Infection (RR=0.42; 95%CrI 0.30–0.75 and RR=0.24; 95%CrI 0.13-0.58) and pulmonary complications (RR=0.57; 95%CrI 0.45–0.77 and RR=0.42; 95%CrI 0.25-0.76) were significantly lower in LapRYGB and RoRYGB vs. OpenRYGB. No differences were found considering postoperative bleeding, thromboembolic complication, 30-day reoperation, and 30-day hospital readmission.ConclusionsThis network meta-analysis suggests that both LapRYGB and RoRYGB appear to be safer compared to OpenRYGB with regard to 30-day mortality, overall, infectious, and pulmonary complications. The surgical management of morbid obesity through RYGB is evolving and the adoption of innovative minimally invasive techniques may finally improve patient outcomes.


پر ارجاع‌ترین مقالات مرتبط:

  • مقاله Surgery
  • ترجمه مقاله Surgery
  • مقاله جراحی
  • ترجمه مقاله جراحی
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