Abstract
The standard size of bougie for laparoscopic sleeve gastrectomy (LSG) is not yet established. Therefore, a systematic review and network meta-analysis were conducted to assess the weight loss effects and associated complications of LSG for patients with morbid obesity, based on different bougie sizes. A total of 15 studies were reviewed in this systemic review and network meta-analysis (2,848 participants), including RCTs and retrospective studies in PubMed, and Embase until September 1, 2020. The effectiveness of different bougie calibration sizes was assessed based on excess weight loss (EWL), total complications, and staple line leak. Within this network meta-analysis, S-sized (≤ 32 Fr.) and M-sized (33–36 Fr.) bougies had similar effects and were associated with the highest EWL improvement among all different bougie sizes (S-sized: standardized mean difference [SMD], 10.52; 95% confidence interval [CI] − 5.59 to − 26.63, surface under the cumulative ranking curve [SUCRA], 0.78; and M-sized: SMD, 10.16; 95% CI − 3.04–23.37; SUCRA, 0.75). M-sized bougie was associated with the lowest incidence of total complications (M-sized: odds ratio, 0.43; 95% CI, 0.16–1.11; SUCRA, 0.92). Based on our network meta-analysis, using M-sized bougie (33–36 Fr.) is an optimal choice to balance the effectiveness and perioperative safety of LSG in the clinical practice.
Highlights
Obesity has been a global endemic with a continuously increasing prevalence
After the initial screening procedure, a total of 25 articles were considered for full-text review; 10 of which were excluded for various reasons
These 15 trials were included in our study, and a total of 2848 participants receiving laparoscopic sleeve gastrectomy (LSG) using different bougie sizes calibrated as XL, L, M, and S were included
Summary
Obesity has been a global endemic with a continuously increasing prevalence. Approximately > 650 million adults are obese in 2016, and worldwide obesity has nearly tripled since 1 9751. For its clinical significance due to comorbidities and associated economic impact, obesity therapies remain very diverse, from basic lifestyle management, diet counseling, physical exercise, medications, endoscopic interventions to invasive bariatric surgical procedures[1,2,3]. Among these therapies, bariatric surgery has been proven as the most effective therapeutic modality for morbid obesity due to its significant weight loss and long-term d urability[4,5]. We performed a network meta-analysis and cataloged results of these controlled trials into a comprehensive systematic review and meta-analysis of available data to determine the standard bougie size for calibration during LSG, based on excess weight loss (EWL), associated complications, and SLL percentage
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