title: Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: a systematic review of randomized trials.
abstract: BACKGROUND
  The evidence regarding the effectiveness and safety of laparoscopic sleeve gastrectomy (LSG) has been mostly based on the data derived from nonrandomized studies. The objective of this study was to evaluate the outcomes of LSG and to present an up-to-date review of the available evidence based on the recent publications of new randomized, controlled trials (RCTs).
  
  
  METHODS
  PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched until November 2012 for RCTs on LSG.
  
  
  RESULTS
  Fifteen RCTs, comprising a total of 1191 patients, of whom 795 had undergone LSG, were included. No patient required conversion to open surgery for LSG, laparoscopic gastric bypass (LGB), or laparoscopic adjustable gastric banding (LAGB) procedures. There were no deaths, and the complication rate was 12.1% (range 10%-13.2%) in the LSG group versus 20.9% (range 10%-26.4%) in the LGB group, and 0% in the LAGB group (only 1 RCT). The complications included leakage, bleeding, stricture, and reoperation that occurred with rates of .9%, 3.3%, 0%, and 2.1%, respectively, in the LSG group and rates of 0%, 5%, 0%, and 4%, respectively, in the LGB group. The average operating time in the LSG group was 106.5 minutes versus 132.3 minutes in the LGB group. The percentage of excess weight loss (%EWL) ranged from 49% to 81% in the LSG group, from 62.1% to 94.4% in the LGB group, and from 28.7% to 48% in the LAGB group, with a follow-up ranging from 6 months to 3 years. The type 2 diabetes mellitus (T2DM) remission rate ranged from 26.5% to 75% in the LSG group and from 42% to 93% in the LGB group.
  
  
  CONCLUSIONS
  LSG is a well-tolerated, feasible procedure with a relatively short operating time. Its effectiveness in terms of weight loss is confirmed for short-term follow-up (≤ 3 years). The role of LSG in the treatment of T2DM requires further investigation.
authors.affiliation: Department of Digestive Surgery and Liver Unit, "St. Maria" Hospital, Terni, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Trastulli
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.forename: Salvatore
authors.initials: S
authors.lastname: Guarino
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Scalercio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
mesh_terms: D050110:Bariatric Surgery; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009767:Obesity, Morbid / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic
keywords: Bariatric surgery; Diabetes mellitus; Gastric sleeve; Laparoscopic sleeve gastrectomy; Metabolic surgery; Sleeve gastrectomy; Systematic review; Weight loss; vertical gastrectomy