Article information
Resumen
Con el objetivo de establecer la evidencia científica disponible respecto a la efectividad y la seguridad de las diferentes técnicas de cirugía bariátrica actualmente en uso, hemos analizado las principales bases de datos electrónicas (PubMed, Medline, Cochrane Library, Índice Médico Español, INAHTA) y en particular la revista Obesity Surgery, reteniendo las revisiones sistemáticas, los estudios comparativos aleatorizados, las cohortes, los casos y controles y las series de casos de amplia muestra y período de seguimiento prolongado.
La cirugía, tanto por vía abierta como laparoscópica, obtiene una mayor pérdida de peso que el tratamiento convencional, con mejoría en la calidad de vida y en las comorbilidades. Existe un nivel de evidencia adecuado de que el bypass gástrico resulta superior a la cirugía restrictiva. La seguridad se reduce a medida que aumenta el nivel de complejidad de la técnica empleada. Las derivaciones biliopancreáticas no han sido sometidas a ningún estudio controlado y aleatorizado.
Palabras clave:
Obesidad mórbida
Cirugía de la obesidad
Medicina basada en la evidencia
To identify the scientific evidence available on the safety and effectiveness of the various bariatric surgical techniques currently in use, we analyzed the main electronic databases (PubMed, Medline, Cochrane Library, Índice Médico Español, INAHTA) and particularly the journal Obesity Surgery. Systematic reviews, randomized comparative studies, cohorts, case control studies and case series with large samples and prolonged follow-up were retrieved.
Both open and laparoscopic surgery provides greater weight loss than conventional treatment, improving quality of life and reducing comorbidity. There is a sufficient level of evidence to indicate that gastric bypass is more effective than restrictive surgery. Safety is inversely correlated with greater technical complexity. No controlled, randomized studies of biliopancreatic diversions have been performed.
Key words:
Morbid obesity
Bariatric surgery
Evidencebased medicine
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