Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

Obes Surg. 2021 Oct;31(10):4528-4541. doi: 10.1007/s11695-021-05643-z. Epub 2021 Aug 7.


Background: Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB.

Methods: MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3-5 years), trial-defined T2DM remission at any time point and perioperative complications.

Results: Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3-5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points.

Conclusion: OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications. Registration number: CRD42020199779 (https:// ).

Keywords: Metabolic surgery; Network meta-analysis; Obesity; Type 2 diabetes.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Bariatric Surgery*
  • Diabetes Mellitus, Type 2* / surgery
  • Gastrectomy
  • Gastric Bypass*
  • Humans
  • Network Meta-Analysis
  • Obesity / complications
  • Obesity / surgery
  • Obesity, Morbid* / surgery
  • Retrospective Studies
  • Treatment Outcome