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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.
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1 Kaohsiung Medical University Hospital/Kaohsiung Medical University, Division of Thoracic Surgery, Department of Surgery, Kaohsiung City, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696); Kaohsiung Medical University Hospital/Kaohsiung Medical University, Weight Management Center, Kaohsiung City, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696); Kaohsiung Medical University, Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung City, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696); Kaohsiung Medical University, Department of Sports Medicine, College of Medicine, Kaohsiung City, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
2 Kaohsiung Medical University Hospital/Kaohsiung Medical University, Department of Surgery, Kaohsiung City, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
3 Changhua Christian Hospital, Department of Neurology, Changhua, Taiwan (GRID:grid.413814.b) (ISNI:0000 0004 0572 7372); Kaohsiung Medical University, School of Medicine, Kaohsiung, Taiwan (GRID:grid.412019.f) (ISNI:0000 0000 9476 5696)
4 National Defense Medical Center, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan (GRID:grid.260565.2) (ISNI:0000 0004 0634 0356)
5 China Medical University Hospital, Body Science and Metabolic Disorders International Medical Center, Taichung City, Taiwan (GRID:grid.411508.9) (ISNI:0000 0004 0572 9415)
6 National Defense Medical Center, Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan (GRID:grid.260565.2) (ISNI:0000 0004 0634 0356)