Surgery for morbid obesity:: Selection of operation based on evidence from literature review

Background: Bariatric surgery is the therapy for morbid obesity. There are a number of surgical procedures, which are performed by open surgery (OS) and more recently also by laparoscopy (LS). The objective of this study was to consider the evidence for the best bariatric surgical options. Methods: Systematic review of the literature was conducted. Morbid obesity studies published between 1990 and 2002 were analyzed. MEDLINE, LiLACS and COCHRANE databases were used, utilizing MeSH terms and free words. Selected studies were analyzed using a specially designed score of methodological quality, to analyze and compare studies. This validated scale is composed by 3 items, and the final score may range between 6 and 36 points. Means, medians and weighted means were calculated, and a comparative analysis by therapy was performed using median 95% confidence intervals (CI). Number of treated patients, reduction in body mass index (BMI), reduction in co-morbidity, %EWL, morbidity and mortality, hospital stay, follow-up, success and failure of operations, and methodological quality were analyzed. Results: 283 related articles were considered. Only 31 of them had selection criteria (these include 5,216 patients operated by OS and 3,230 by LS). Operative mortality was 0.0% for OS and 0.4% for LS. At 36 months, OS techniques show reduction in BMI, %EWL and reductions in co-morbidity of 30.9%, 61.9% and 74.1% respectively. At 36 months, LS techniques show reduction in BMI, %EWL and reduction in comorbidity of 23.7%, 55.9% and 70.9%. Hospital stay was 3.8 days for LS and 7 for OS. At 2-year follow-up, morbidity was 14.8% for LS and 16.7% for OS, and reoperations were 17.7% for LS and 11.3% for OS. Median score for methodological quality was 13 for OS and 11 for LS. Conclusions: Methodological quality of primary studies to 2002 has been poor.