Bariatric surgery has been proven to be more effective than other measures such as medications and lifestyle interventions for weight loss. There are a number of bariatric surgical procedures currently available, and the most commonly performed procedures are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB). RYGB involves restricting the size of the stomach to create a much smaller gastric pouch, and attaching the pouch to the mid-jejunum, resulting in malabsorption of food. SG involves removing the greater fundus and curvature of the stomach, creating a much smaller tube-like stomach, thereby restricting food intake. LAGB uses a band that is encircled around the top of the stomach. The band is connected to a subcutaneous port that can be used to inflate the band, increasing the restriction on the stomach. Each procedure is associated with benefits and risks; therefore, the purpose of this review is to compare the clinical effectiveness, safety, and cost-effectiveness of the RYGB, SG, and LAGB procedures amongst one another in obese and morbidly obese patients. This report builds on a Rapid Response report completed in August 2013, which focused on the evidence for prioritizing patients for bariatric surgery.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
  • Limitations
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• REFERENCES
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Characteristics of the Individual Included Studies
• APPENDIX 3 Characteristics of the Included Economic Analyses
• APPENDIX 4 Critical Appraisal of Included Studies
• APPENDIX 5 Main Study Findings and Authors’ Conclusions

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources and a summary of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.