W. Ahmed1, K. Jawed1, A. Ahmed4, M. Barolia1, S. Mehdi1, N. Paryani4, T. Murali3, R. Martins2 1Aga Khan University Medical College, Medical College, Karachi, Sindh, Pakistan 2Hackensack Meridian School Of Medicine, Division Of Thoracic Surgery, Department Of Surgery, Central Region, NEW JERSEY, USA 3University Of New Mexico HSC, School Of Medicine, Albuquerque, NM, USA 4Dow University of Health Sciences, Medical College, Karachi, SINDH, Pakistan
Introduction:
The volume of bariatric procedures among adolescents in the United States (US) has doubled over the last decade, with increasing interest regarding optimal surgical techniques. This meta-analysis compares outcomes of the three most commonly used bariatric procedures among adolescents.
Methods:
Medline and Cochrane databases were systematically searched from inception-June 2023. We included all studies comparing outcomes of at least two of gastric bypass (GB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB) in adolescents (age ≤ 21 years). Random effects models were utilized to pool dichotomous outcomes as risk ratios (RRs) and continuous outcomes as mean differences (MDs).
Results:
Fourteen observational studies comprising 14,041 patients were meta-analyzed.
The percentage change in BMI was significantly greater in patients undergoing SG (MD: -13.76) and GB (MD: -11.36) as compared to AGB, and GB when compared to SG (MD: -3.01) (Figure 1A).
On subgroup analyses according to reported outcome, GB resulted in significantly greater percentage change in weight than SG; SG and GB resulted in significantly greater absolute weight change than AGB; and GB resulted in a significantly greater absolute change in BMI compared to SG which itself was superior to AGB (Figure 1A).
In comparison to GB, both SG (RR: 0.48) and AGB (RR: 0.28) were associated with significantly fewer post-operative complications. SG also had significantly shorter operative times than GB (MD: -24.62) (Figures 1B and 1C).
Meanwhile, rates of post-operative resolution of baseline diabetes mellitus were comparable between SG and GB (Figure 1D).
Conclusion:
Our meta-analysis, the first of its kind, shows that while GB may be the most effective for weight loss in adolescents, SG and AGB are potentially safer options. Given the absence of level 1 evidence, future randomized control trials must directly compare the efficacy (using standardized and appropriate weight-loss measures) and safety of the various bariatric surgical techniques.
