Studies of Swedish adjustable gastric band and Lap-Band: systematic review and meta-analysis

Background: This is the first systematic review and meta-analysis of the large body of data describing the Swedish adjustable gastric band (SAGB) and Lap-Band (LB). Methods: A systematic review was performed that included screening of studies published in any language (January, 1 1998 through April 30, 2006) identified through MEDLINE Current Contents, or the Cochrane Library. Studies with >= 10 SAGB or I-B patients reporting >= 30-day efficacy or safety outcomes were eligible for review; the data were extracted from the accepted studies. A weighted means analysis and random-effects meta-analysis of efficacy outcomes of interest were conducted. Results: A total of 4592 bariatric surgery Studies met the initial criteria. Of these studies, 129 (28,980 patients) were accepted (33 SAGB and 104 LB studies): most had a retrospective single-center design. For 4273 patients (36 treatment groups) in 33 SAGB Studies and 24,707 patients (111 groups) in 104 LB studies. the mean baseline age (39.1-40.2 yr), body mass index (43.8-45.3 kg/m(2))and gender (women 79.2-92.5%) were similar. A laparoscopic technique Was used in >= 88% and a pars flaccida technique in >= 41% of both groups. Early mortality was equivalent for SAGB/LB (<=.1%). The 3-year mean SAGB and LB excess weight loss (56.36% and 50.20%, respectively) and body mass index reduction (-11.99 and -11.81 kg/m(2), respectively) from baseline were statistically significant (P <.05), as was the resolution of diabetes (61.45% and 60.29%, respectively) and hypertension (62.95% and 43.58%, respectively). Although scant and inconsistently reported data precluded direct statistical comparisons, the complication rates for the 2 devices appeared comparable. In 8 directly comparative studies. meta-analysis found a significantly greater absolute weight loss (P <.05) with the SAGB at 2 years (48.4 versus 41.9 kg, mean difference -4.84, 95% confidence interval -9.47 to -0.22), although no difference was found in the percentage of excess weight loss or change in body mass index. Conclusion: In a systematic review of the published world SAGB and LB data. at 1, 2, and 3 years. the weight loss, resolution of diabetes and hypertension. and complications appeared comparable. (Surg Obes Relat Dis 2008 4:1 74-185.) (C) 2008 American Society for Metabolic and Bariatric surgery. All rights reserved.