INTRODUCTION
Obesity stands out as a multifactorial disease that can cause several public health problems [1]. Currently, 30% of the world’s population is overweight or obese. By 2020, it is estimated that more than 60% of the world’s population will be overweight or obese. Estimates suggest that the prevalence of severe obesity in 2030 will be 11%, approximately twice the current prevalence [2]. In this context, there are 2.0 billion overweight and obese people in the world [3], and Brazil is in fifth place in the world ranking, with an estimated 18.0 million people, tending to reach over 70.0 million [4]. In 2019, according to a survey carried out by the Ministry of Health, 52.5% of Brazilians are overweight [5].
The Roux-en-Y gastric bypass technique (BGYR) is one of the most performed techniques in Brazil and in the world, together with vertical gastrectomy (around 1: 1) [1]. The Gastric Bypass technique presented in Latin America about 3,195 bariatric operations in 2008, while in 2018 there were 10,852, an increase of 339%. BGYR can promote up to 75.0% of initial excess weight loss in the period of 18 to 24 months but with a long-term failure rate ranging from 10.0% to 35.0% [5,6]. In superobese (BMI> 50), the impossibility of reaching a BMI below 35 can reach up to 60% of cases [8].
Despite this, bariatric surgery can lead to postoperative complications. The most feared complications in the postoperative period, responsible for mortality rates between 0.1 and 0.5%, include sepsis of abdominal origin, caused by suture or anastomosis dehiscence, pulmonary thromboembolism [9,10] and recurrence of obesity, in which the main associated factors are food error and bad lifestyle habits associated with a sedentary lifestyle, resulting in an increased gastric reservoir and consequent dilation of the anastomosis [11,12].
In this sense, the efficacy and safety of narrowing the gastrojejunal anastomosis using the techniques of Argon Plasma Coagulation (APC), Suturing (SUT), and surgical procedures (SUR) in the recurrence of obesity after bariatric surgery is still under discussion [8]. Thus, it is imperative to better know and compare the scientific results among these procedures in order to offer patients an adequate and effective treatment for relapsed weight. Thus, the main endoscopic procedures are the Endocinch, the Stomaphyx, the ROSE procedure, the Overstitch of Apollo Endosurgery, the OTSC clip, and the glare of the gastrojejunal anastomosis with argon described by Aly in 2009 [13].
In this context, the present study aimed to make a systematic review of the literature followed by a meta-analysis by means of statistical treatment on the exponent subject of the reduction of gastrojejunal anastomosis using the three modalities of argon plasma, suturing, and surgery, in order to elucidate more clearly the safety and efficacy of using argon plasma compared to other procedures.