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Intervention Review

Surgery for obesity

  1. Jill L Colquitt*,
  2. Joanna Picot,
  3. Emma Loveman,
  4. Andrew J Clegg

Editorial Group: Cochrane Metabolic and Endocrine Disorders Group

Published Online: 15 APR 2009

Assessed as up-to-date: 26 OCT 2008

DOI: 10.1002/14651858.CD003641.pub3


How to Cite

Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003641. DOI: 10.1002/14651858.CD003641.pub3.

Author Information

  1. University of Southampton, Southampton Health Technology Assessments Centre, Southampton, Hampshire, UK

*Jill L Colquitt, Southampton Health Technology Assessments Centre, University of Southampton, First Floor, Epsilon House, Enterprise Road, Southampton Science Park, Chilworth, Southampton, Hampshire, SO16 7NS, UK. j.colquitt@soton.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Plain language summary

Background

Bariatric (weight loss) surgery for obesity is considered when other treatments have failed. The effects of the available bariatric procedures compared with medical management and with each other are uncertain. This is an update of a Cochrane review first published in 2003 and previously updated in 2005.

Objectives

To assess the effects of bariatric surgery for obesity.

Search methods

Studies were obtained from computerized searches of multiple electronic bibliographic databases, supplemented with searches of reference lists and consultation with experts in obesity research.

Selection criteria

Randomised controlled trials (RCTs) comparing different surgical procedures, and RCTs, controlled clinical trials and prospective cohort studies comparing surgery with non-surgical management for obesity.

Data collection and analysis

Data were extracted by one reviewer and checked independently by two reviewers. Two reviewers independently assessed trial quality.

Main results

Twenty six studies were included. Three RCTs and three prospective cohort studies compared surgery with non-surgical management, and 20 RCTs compared different bariatric procedures. The risk of bias of many trials was uncertain; just five had adequate allocation concealment. A meta-analysis was not appropriate.

Surgery results in greater weight loss than conventional treatment in moderate (body mass index greater than 30) as well as severe obesity. Reductions in comorbidities, such as diabetes and hypertension, also occur. Improvements in health-related quality of life occurred after two years, but effects at ten years are less clear.

Surgery is associated with complications, such as pulmonary embolism, and some postoperative deaths occurred.

Five different bariatric procedures were assessed, but some comparisons were assessed by just one trial. The limited evidence suggests that weight loss following gastric bypass is greater than vertical banded gastroplasty or adjustable gastric banding, but similar to isolated sleeve gastrectomy and banded gastric bypass. Isolated sleeve gastrectomy appears to result in greater weight loss than adjustable gastric banding. Evidence comparing vertical banded gastroplasty with adjustable gastric banding is inconclusive. Data on the comparative safety of the bariatric procedures was limited.

Weight loss and quality of life were similar between open and laparoscopic surgery. Conversion from laparoscopic to open surgery may occur.

Authors' conclusions

Surgery is more effective than conventional management. Certain procedures produce greater weight loss, but data are limited. The evidence on safety is even less clear. Due to limited evidence and poor quality of the trials, caution is required when interpreting comparative safety and effectiveness.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Plain language summary

Weight loss surgery for obesity

Obesity is associated with many health problems and a higher risk of death. Bariatric (weight loss) surgery for obesity is usually only considered when all other treatments have failed. People who are eligible for surgery have a body mass index (BMI) greater than 40 or greater than 35 with related conditions such as type 2 diabetes. Recently, it has been suggested that people with a lower BMI may benefit from surgery.

A number of different bariatric procedures are available, and these can be carried out through open (traditional) surgery or laparoscopic (keyhole) surgery. It is not clear which procedures are the most effective in reducing weight or have the least complications. The review aimed to compare these bariatric procedures with each other and with conventional treatment (such as drugs, diet and exercise).

The review found that surgery results in greater weight loss than conventional treatment in people with BMI greater than 30 as well as those with more severe obesity. Surgery also leads to some improvements in quality of life and obesity related diseases such as hypertension and diabetes. However, complications (for example pulmonary embolism), side-effects (for example heartburn) and some deaths may occur. Although several different surgical procedures are available, not all have been compared with each other. Gastric bypass had greater weight loss than vertical banded gastroplasty or adjustable gastric banding, but similar to isolated sleeve gastrectomy and banded gastric bypass. Isolated sleeve gastrectomy appears to result in greater weight loss than adjustable gastric banding. The evidence comparing vertical banded gastroplasty with adjustable gastric banding was not clear. Complications may occur with any bariatric procedure, but information from the included trials did not allow us to reach any conclusions about the safety of these procedures compared with each other.

Weight loss following open and laparoscopic surgery was similar. Recovery was often quicker following laparoscopic surgery, with fewer wound problems, although some studies found more reoperations were needed.

In conclusion, the review found that surgery is more effective than conventional management. Certain procedures appear to result in greater weight loss than others, but this is based on a very small number of trials. The evidence on the safety of these procedures compared with each other is even less clear. Due to the poor quality and small number of trials comparing each pair of procedures the information should be viewed with caution.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Plain language summary

肥胖的外科治療

研究背景

◆ 當其他方法失效的時候,可考慮以減重手術來治療肥胖。現行減重手術與藥物治療和其他治療方式效果的比較尚不明確。這是一篇對於考科藍在2003年發表、2005年更新過的統整資料的更新。

研究目的

評估減重手術治療肥胖的成效。

检索方法

研究取材自多個電子資料庫與搜尋參考書目並且諮詢肥胖症領域的專家。

纳入标准

比較各種不同的外科手術的隨機對照試驗。比較手術與非手術治療肥胖的隨機對照試驗、對照臨床試驗和前瞻性試驗

数据收集与分析

由一位審查者擷取資料,由二位審查者獨立審核。二位審查者獨立評估試驗的品質。

主要结果

有二十六個研究被囊括在內。其中有三個隨機對照試驗與三個前瞻性研究是比較外科與非外科治療的差別,有20個隨機對照試驗是比較不同手術方式的差別。許多研究的風險誤差並不確定,只有五個研究有適當的分派隱藏。整合分析是不合適的。 在中度(身體質量指數大於30)與重度肥胖症中,外科比傳統治療減輕較多的體重,也減少較多的併發症,例如糖尿病和高血壓。在兩年後,與健康相關的生活品質有改善,但十年後的效益尚未明確。 外科手術與一些併發症有關,譬如肺栓塞,術後死亡也可能發生。 五種不同的減重手術方式被做了評估,但某些比較僅在一個試驗中進行。有限的證據顯示:胃繞道手術比垂直束帶胃整型手術或可調整式胃束帶手術降低更多的體重,但與胃袖套狀切除術、束帶型胃繞道手術差不多。胃袖套狀切除術比調整型胃束帶手術降低更多的體重。垂直束帶胃整型手術與調整型胃束帶手術兩者間相比較的證據尚不明確。關於減重手術安全性比較的資料很有限。剖腹手術與腹腔鏡手術造成之體重減輕與生活品質相似。由腹腔鏡手術轉為傳統手術的情況可能發生。

作者结论

外科手術比傳統治療更有效。某些術式能夠產生更多的體重下降,但資料有限。有關於安全性的資料更少。由於證據有限以及試驗品質不良,在於解讀安全性與效度比較時需要非常小心。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Plain language summary

肥胖的外科治療

減重手術跟許多健康問題相關並且具有高的死亡風險。通常只在其他治療失敗時才會考慮減重手術。符合手術資格的人包括身體質量指數大於40或身體質量指數大於35合併其它相關狀況如第二型糖尿病。最近研究則暗示有較低身體質量指數的人也可能從手術中獲益。 手術方式有很多種,可能經由傳統開腹手術或腹腔鏡手術執行。何種術式最能有效減重或併發症最少並不清楚。此回顧的目的是比較這些手術和傳統治療方法(如藥物、飲食控制和運動)的差別。 此回顧發現外科跟傳統治療比較,在中度(身體質量指數大於30)與嚴重肥胖症上,能達到較多的體重減輕。手術同時會改善生活品質及和肥胖相關的疾病如高血壓和糖尿病,但可能發生併發症(如肺栓塞)、副作用(如心灼熱感)甚至死亡。雖然有許多不同術式可用,但並非所有術式都與其他術式比較過。胃繞道手術比垂直束帶胃整型手術或調整型胃束帶手術降低更多體重,但與胃袖套狀切除術、束帶型胃繞道手術差不多。胃袖套狀切除術比調整型胃束帶手術降低更多體重。垂直束帶胃整型手術與調整型胃束帶手術兩者間比較的證據較不明確。任何術式都可能發生併發症,但各術式間的安全性比較並無法從這些研究中得知。 體重減輕程度在開腹手術和腹腔鏡手術後結果類似。腹腔鏡手術恢復較快、傷口問題較少,雖然有些研究顯示病人需要再次接受手術的機會較高。 總結來說,此回顧發現手術比傳統治療有效。某些術式似乎能造成較多的體重減輕,但這是基於很少數量的研究結果。關於不同減重手術之間安全性比較的證據甚至更不清楚。由於試驗的數量很少且試驗品質不良,解讀這些資訊時要非常小心。 ◆

翻译注解

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要
  6. Plain language summary

Kirurški zahvati za liječenje debljine

Kirurški zahvati za liječenje debljine

Debljina je povezana s nizom zdravstvenih problema i većim rizikom od umiranja. Barijatrijska kirurgija, odnosno kirurgija koja se provodi s ciljem smanjenja tjelesne težine, obično se razmatra kad svi drugi oblici liječenja propadnu. Osobe koje dolaze u obzir za kirurški zahvat imaju indeks tjelesne mase veći od 40, ili veći od 35 ako imaju stanja kao što je dijabetes tipa 2. Pretpostavlja se da bi i osobe s manjim indeksom tjelesne mase mogle imati koristi od kirurškog zahvata.

Postoji niz različitih barijatrijskih zahvata, a mogu se provoditi otvorenom (tradicionalnom) kirurgijom ili laparoskopski. Nije poznato koja vrsta zahvata je najučinkovitija za smanjenje tjelesne težine ili ima najmanje komplikacija. U ovom Cochrane sustavnom pregledu uspoređeni su barijatrijski zahvati međusobno i s drugim standardnim postupcima kao što su lijekovi, dijete i tjelovježba.

Sustavni pregled literature je pokazao da kirurški zahvat omogućuje veći gubitak težine nego standardni postupci u osoba s indeksom tjelesne mase većim od 30, kao i u osoba s izraženijom debljinom. Kirurgija također omogućuje određeno poboljšanje kvalitete života i bolesti povezanih s debljinom kao što su hipertenzija i dijabetes. Međutim, može uzrokovati komplikacije (primjerice, plućna embolija), nuspojave (kao što je žgaravica) i određeni broj smrti.Iako postoji nekoliko različitih kirurških postupaka, u kliničkim studijama nisu svi međusobno uspoređivani. Želučana premosnica (engl. gastric bypass) dovela je do većeg gubitka težine nego vertikalna gastroplastika (engl. vertical banded gastroplasty) ili podvezivanje želuca podesivom trakom (engl. adjustable gastric banding), ali je dalo slične rezultate kao uklanjanje većeg dijela želuca (engl. isolated sleeve gastrectomy) i kombinacija želučane premosnice i trake oko stomaka (engl. banded gastric bypass). Čini se da uklanjanje većeg dijela želuca dovodi do većeg gubitka težine nego kombinacija želučane premosnice i trake oko stomaka. Dokazi koji uspoređuju vertikalnu gastroplastiku i podvezivanje želuca podesivom trakom nisu bili jasni. Komplikacije mogu nastati uslijed bilo kojeg barijatrijskog zahvata, ali informacije iz uključenih kliničkih studija nisu dozvoljavale donošenje bilo kakvih zaključaka o sigurnosti tih postupaka, u međusobnoj usporedbi.

Gubitak težine nakon otvorene i laparoskopske kirurgije bio je sličan. Oporavak je obično brži nakon laparoskopske kirurgije, kod koje nastaje i manje problema s kirurškom ranom, iako su neke studije pokazale da je kod laparoskopskih operacija češće potrebna ponovna operacija.

Zaključno, sustavnim pregledom je utvrđeno da je kirurgija učinkovitija nego standardni postupci za smanjenje tjelesne težine. Određeni kirurški postupci dovode do značajnijeg mršavljenja u usporedbi s drugima, ali taj se zaključak temelji na malom broju studija. Dokazi o sigurnosti tih postupaka, kad se usporede međusobno, još su manje jasni. Zbog loše kvalitete i malog broja studija u kojima su kirurški zahvati međusobno uspoređeni, informacije o njima treba razmotriti s oprezom.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre