Comparing Minimally Invasive Bariatric Techniques: A Systematic Review of Robotic Sleeve Gastrectomy vs. Endoscopic Sleeve Gastroplasty

Comparing Minimally Invasive Bariatric Techniques: A Systematic Review of Robotic Sleeve Gastrectomy vs. Endoscopic Sleeve Gastroplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparing Minimally Invasive Bariatric Techniques: A Systematic Review of Robotic Sleeve Gastrectomy vs. Endoscopic Sleeve Gastroplasty Yusuf-Zain Ansari, Tarek Elsabbagh, Ramdhan Russell, Yuval Shimoni, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5040568/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Within bariatric surgery, endoscopic sleeve gastroplasty (ESG) and robotic sleeve gastrectomy (RSG) have emerged as minimally invasive procedures for weight loss and metabolic management. While both offer benefits for obesity, the comparative effects in terms of weight loss, efficacy, and safety remain uncertain. Methods A systematic search of PubMed/MEDLINE, and Cochrane Library was conducted to collect both prospective and retrospective studies assessing the effectiveness and safety of RSG and ESG in treating morbid obesity. Regression analysis was performed. Results We collected eleven studies (1182 patients) evaluating RSG and fourteen studies (3077 patients) evaluating ESG. Average patient ages for RSG were 42.79±11.31 years (63.9% females) with preoperative Body Mass Index of 47.81+8.00 and 38.52±9.69 years (86.1% females) with BMI of 35.20±4.29 for ESG. Mean operation time was 104.93 minutes for RSG, and 68.4 for ESG. RSG yielded a Estimated Weight Loss % (%EWL) of 51.26% at 18 months, while ESG yielded 73.01%. Complication rates were 2.71% (32/1182) for RSG and 8.88% (273/3077) for ESG, while reoperation rates were 0.59% for RSG and 1.34% for ESG. Average hospital stays were 2.71 days for RSG and 0.68 days for ESG. Conclusion The long-term clinical results of RSG and ESG for morbid obesity show similarly favorable outcomes. ESG has shorter operative times and hospital stays, but more complications. Additional research with larger cohorts and randomized trials is needed to determine the preferred procedure. Bariatric surgery Endoscopic sleeve gastroplasty (ESG) Robotic sleeve gastrectomy (RSG) EWL Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction As obesity escalates into a global crisis, research increasingly points to bariatric surgery as a more effective intervention than traditional treatment methods, including lifestyle changes and pharmacotherapy. 1 Bariatric surgery began in 1954 with a simple small bowel bypass to reduce the absorptive capacity of the stomach. 2 During the 1970s, the evolution from earlier forms of bariatric surgery pioneered by Kremen to stomach stapling marked a significant shift towards techniques more akin to those used in contemporary procedures. The advent of the BioEnterics® Lap-Band ® system, quickly pushed the laparoscopic technique to the forefront of bariatric surgery. 3 While laparoscopic techniques are still the standard for bariatric procedures, the use of robotic-assisted surgery has become increasingly popular. These robotic surgeries, typically done with the da Vinci Surgical System, allow for minimally invasive procedures that provide improved precision and visualization for the surgeon. 4 One of the more prominent robotic procedures to treat obesity is the robotic sleeve gastrectomy (RSG). Like the laparoscopic sleeve gastrectomy, RSG reduces the stomach size by ~ 80% to limit the amount of food a patient can hold as well as alter stomach hormones to decrease appetite and increase satiety, promoting weight loss for the patient. Endoscopic bariatric treatments have developed within the last decade, boasting higher patient acceptance due to the minimally invasive and anatomic-preserving nature of the procedures. 5 The most commonly practiced endoscopic bariatric treatments are intragastric balloons, endoscopic duodenal-jejunal bypass liners, and endoscopic sleeve gastroplasty (ESG). The pathophysiological mechanisms of endoscopic procedures are similar to those of surgical bariatric surgeries by limiting gastric capacity, reducing nutrient absorption, and facilitating the non-absorbed discharge of gastric contents. 6 In this study, we aim to summarize the existing literature and compare surgical outcomes for RSG and ESG. Methods and Materials Literature Search The article selection process was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement in order to retrieve all the relevant articles within the known literature 7 . The following keywords were used in every possible combination within Google Scholar, Pubmed/Medline, and Cochrane Library: “endoscopic sleeve gastroplasty,” “robotic sleeve gastrectomy,” and “sleeve gastrectomy”. All the studies were searched before October 23, 2023 and search queries were limited to only display articles written in the English language. Duplicate articles were identified and removed from our system. Inclusion and Exclusion Criteria To be eligible for selection within this systematic review, articles were required to meet the following criteria: (1) assessing the efficacy and safety of RSG and ESG in the treatment of morbid obesity, (2) prospective or retrospective studies, (3) published from 2010 to 2023, and (4) published in the English language. We excluded articles that met the following criteria: (1) large database studies, (2) individual case series, (3) abstracts, letters, or reviews without original data, and (4) studies with no reported outcomes of interest. The primary objective endpoints were %EWL (excess weight loss), operative time, length of stay, reoperation, complications, and conversion to open surgery. Data Extraction Eligible articles were reassessed by two independent reviewers to confirm all inclusion criteria were met. If any disagreement or discrepancy occurred in the studies, the two reviewers consulted the guarantor author. For each article, the following data was recorded: demographics (including number of patients, mean age, sex, comorbidities, and preoperative body mass index (BMI)); mean operative time; estimated blood loss; length of stay; reoperation; intraoperative and post-operative complications; conversion to open surgery; %EWL (excess weight loss) after 1, 3, 6, 12, 18 months; and comorbidity relief. For continuous outcomes, the mean, standard deviation, and number of patients were recorded. We calculated standard deviation using available data when it was not provided. Three independent reviewers ensured accurate data extraction. Statistical Analysis Regarding the categorical outcomes, the odds ratio (OR) and 95% confidence interval (CI) were calculated, based on the extracted data, by means of a fixed-effects model (Mantel-Haenszel statistical method), where the number of studies providing data was sufficient. OR < 1 denoted that outcome was more frequent in the RSG group. Continuous outcomes were evaluated by means of weighted mean difference (WMD) with its 95% CI, using fixed-effects and random-effects (inverse variance statistical method) models, appropriately to calculate pooled effect estimates. In cases where WMD < 0, values in the RSG group were higher. Between studies, heterogeneity was assessed using Cochran’s Q statistic and by estimation. Results Article Selection Results Our literature review selected twenty-four studies from various countries including the United States, Brazil, India, Spain, Greece, Portugal, Saudi Arabia, and France, spanning from 2010 to October 2023. The key details of these articles are summarized in Table 1 . The article selection process is shown below in Fig. 1. 8 Table 1 Characteristics of included studies First author, Year Journal Country Robotic Sleeve Gastrectomy Ayloo, 2011 9 J Laparoendosc Adv Surg Tech A United States Diamantis, 2010 11 Obes Surg Greece Ecker, 2016 12 Surg Obes Relat Dis United States Elli, 2014 13 Obes Surg United States Kannan, 2015 14 Surg Obes Relat Dis United States Moon, 2016 15 Obes Surg United States Pepper, 2016 16 Obes Surg United States Romero, 2013 17 Obes Surg United States Schraibman, 2014 18 Obes Surg Brazil Vilallonga, 2013 19 Obes Surg Spain Endoscopic Sleeve Gastroplasty Abu Dayyeh, 2022 20 Lancet United States Abu Dayyeh, 2017 21 Clin Gastroenterol Hepatol United States Alexandre, 2023 22 J Visc Surg France Alqahtani, 2023 23 Am J Gastroenterol Saudi Arabia Alqahtani, 2019 24 Clin Endosc Saudi Arabia Barrichello, 2019 25 Clin Endosc Brazil, United States Correia, 2023 26 Surg Endosc Portugal Fayad, 2019 27 Clin Endosc United States Lopez-Nava, 2017 28 Arq Bras Cir Dig Spain Maselli, 2023 29 WGJE Brazil/United States Maselli, 2021 30 Clin Endosc United States, UAE, Saudi Arabia, Brazil Morales, 2018 31 Surg Endosc Spain Sartoretto, 2018 32 Obes Surg Australia/United States Figure 1. PRISMA diagram Table 1 . Characteristics of included studies Patient Demographics This systematic review synthesized data from 24 studies, encompassing a total of 5259 patients, with 1182 undergoing Robotic Sleeve Gastrectomy (RSG) and 4077 undergoing Endoscopic Sleeve Gastroplasty (ESG). The demographic breakdown indicated 991 females and 4268 males, with ESG and RSG procedures being performed on 565 females and 3512 males, and 426 females and 755 males, respectively. The average age of patients was 37.49 ± 9.64 years for ESG and 42.79 ± 11.38 years for RSG. Furthermore, the average preoperative BMI was 34.74 ± 4.3 for ESG patients and 47.81 ± 8.08 for RSG patients. Detailed patient demographics and intraoperative parameters for each individual study are displayed in Table 2 , while aggregated data across all studies are presented in Table 3 , offering a comprehensive overview of patient profiles and procedural specifics within this comparative analysis. Table 2 Intraoperative parameters of each study 9 – 32 First author, Year Number of Patients Female (%) Mean age Mean pre-op BMI Length of stay (days) Mean operative time (min) Intraoperativecomplication rate (%) Conversion rate (%) Robotic Sleeve Gastrectomy Ayloo, 2011 30 96.7 38 ± 9.1 57 2.6 ± 1.2 135 ± 28 0 0 Bhatia, 2014 35 42.9 41.7 ± 3.43 48.17 3.36 ± .37 116.6 ± 48.8 0 0 Diamantis, 2010 19 89.5 39.4 ± 10.9 48.2 4 95.5 ± 11.5 0 0 Ecker, 2016 415 74.0 43.6 ± 11.2 48.7 3 96.4 ± 24.9 1 .24 Elli, 2014 105 90.5 41 ± 10.2 49 2.44 ± 0.746 110.6 ± 48.27 0 0 Kannan, 2015 46 60.9 46 48.69 ± 9.59 4.2 ± 0.9 110 0 0 Moon, 2016 268 29.1 43.4 ± 11.9 46.7 ± 7.7 1.7 ± 1.8 N/A 0 0 Pepper, 2016 14 85.7 17 43 2.8125 131.5 0 0 Romero, 2013 134 66.4 43 ± 12.6 45 2.2 ± 0.6 106.6 ± 48.8 0 0 Schraibman, 2014 16 37.5 43 ± 16 41.3 3 148 0 0 Vilallonga, 2013 100 79.0 44 ± 11 48 4 ± 3 108 ± 18 5 0 Endoscopic Sleeve Gastroplasty Abu Dayyeh, 2022 77 88.3 47.3 ± 9.3 35.5 ± 2.6 N/A N/A 0 0 Abu Dayyeh, 2017 25 84.0 47.6 ± 10 35.5 ± 2.6 N/A N/A 0 0 Alexandre, 2023 99 74.7 45 ± 12.7 42.7 ± 7.8 1 38 ± 2.95 0 0 Alqahtani, 2023 656 93.9 33.6 ± 9 28.9 ± 0.8 N/A 51 ± 18 0 Alqahtani, 2019 1000 89.7 34.4 ± 9.5 33.3 ± 4.5 0.5 82 ± 20 0 0 Barrichello, 2019 193 76.7 42.3 ± 9.6 34.11 ± 2.97 0.5 76 ± 24 0 0 Correia, 2023 73 83.6 49.2 ± 9.7 38.60 ± 3.51 2 83 ± 20 0 1.4 Fayad, 2019 54 57.4 N/A 43.07 ± 0 .34 ± .73 N/A 0 0 Lopez-Nava, 2017 154 70.1 44.9 ± 9.5 38.3 ± 5.5 1 N/A 0 0 Maselli, 2023 404 78.5 42.9 44.8 ± 4.7 N/A 42 ± 9 0 0 Maselli, 2021 82 92.7 42.8 ± 10.4 37.2 ± 5.7 0.5 48.3 ± 20.5 0 0 Morales, 2018 148 81.8 41.52 ± 10 35.11 ± 5.5 1 45 ± 60 2 0 Sartoretto, 2018 112 68.8 45.1 ± 11.7 37.9 ± 6.7 1 N/A 0 0 Table 3 Patient characteristics across all studies Perioperative data ESG RSG Patients 3077 1182 Age 38.52 ± 9.69 42.79 ± 11.31 Female/Male 565/3512 426/755 Pre-op BMI 35.20 ± 4.29 47.81 ± 8.00 Major Comorbidities Diabetes Hypertension GERD Sleep Apnea Other 235 Patients 361 Patients 87 Patients 90 Patients 285 Patients 304 Patients 462 Patients 11 Patients 405 Patients 390 Patients Operation Time (minutes) 63.10 ± 22.58 104.93 ± 32.43 Length of Stay (days) 0.68 2.71 ± 1.89 Table 2 . Intraoperative parameters of each study 9 – 32 Table 3 . Patient characteristics across all studies The review also focused on major comorbidities, including diabetes, hypertension, Gastroesophageal Reflux Disease (GERD), and sleep apnea, although not all studies provided details on these conditions. In total, among the patients with disclosed comorbidities, 539 had diabetes, 823 had hypertension, 98 had GERD, 495 had sleep apnea, and 675 had other comorbidities. Specifically, for ESG, among 1058 patients with known comorbidities, 22% were diagnosed with diabetes, 34% with hypertension, 8% with GERD, 9% with sleep apnea, and 27% with other conditions. For RSG, among 1572 patients with disclosed comorbidities, 19% had diabetes, 29% had hypertension, 1% had GERD, 26% had sleep apnea, and 25% had other comorbidities. Clinical Outcomes In this systematic review, we evaluated five critical factors to discern the differences between ESG and RSG: percent excess weight loss (%EWL) over time, postoperative complication rates, reoperation rates, rates of conversion to open surgery, average hospital length of stay, and mean operative times. The %EWL observed in ESG patients at 1, 3, 6, 12, and 18 months post-procedure were 36.29 ± 31.60, 42.58 ± 35.02, 58.32 ± 39.80, 67.21 ± 44.50, and 65.63 ± 54.81, respectively. Conversely, RSG patients reported %EWL of 16.56 ± 8.67, 25.21 ± 10.73, 43.96 ± 8.04, 65.51 ± 23.50, and 51.26 at corresponding intervals, showing that ESG patients consistently achieved higher %EWL at all monitored stages. A total of 330 postoperative complications were documented, with 288 occurring in ESG patients and 42 in RSG patients. The ESG cohort had a reoperation rate of 1.35% and a conversion rate to open surgery of 0.025%, while the RSG cohort exhibited a reoperation rate of 0.76% and a conversion rate to open surgery of 0.085%. Furthermore, the average hospital stay was significantly shorter for ESG patients at 0.97 ± 0.73 days, compared to 2.71 ± 1.89 days for RSG patients, emphasizing ESG's minimally invasive approach. An important operational distinction was found in the mean operative times: ESG procedures averaged 68.4 ± 18.66 minutes, while RSG procedures took longer, with an average of 104.93 ± 33.66 minutes. This indicates that overall, the RSG procedure is more time-consuming, reflecting the complexity and technical demands of robotic surgery compared to the more streamlined ESG process. The detailed post-operative outcomes for each individual study are compiled in Table 4 , while a comprehensive overview of outcomes across all analyzed studies is presented in Table 5 . This structured presentation of data provides a transparent comparison of the efficacy, safety, and operational efficiencies of ESG and RSG, contributing to a nuanced understanding of their relative benefits and challenges in managing obesity. Table 4 Post-operative outcomes of each study 9 – 32 First Author, Year Follow-up period (months) %EWL (3 month) %EWL (6 month) %EWL (12 month) %EWL (24 month) Reoperation Rate (%) Postoperative complications (%) Robotic Sleeve Gastrectomy Ayloo, 2011 12 N/A N/A N/A N/A 3.33 0 Bhatia, 2014 6 N/A 42.8 ± 3.6 N/A N/A 0 0 Diamantis, 2010 1 (n = 19) 3 (n = 19) 6 (n = 16) 12 (n = 16) 1.3 ± 7.5 4.1 ± 13.2 65.5 ± 25.6 N/A 0 0 Ecker, 2016 N/A N/A N/A N/A N/A 5.06 7.22 Elli, 2014 3 (n = 71), 6 (n = 69), 9 (n = 44), 12 (n = 38), 18 (n = 23), 24 (n = 23), 36 (n = 15), > 36 (n = 11) 22.49 44.52 48.89 43.44 0 0 Kannan, 2015 3 (n = 43), 6 (n = 30), 12 (n = 26) 27 ± 11.03 39.0 ± 12.0 57.0 ± 20.4 N/A 15.2 2.17 Moon, 2016 1 N/A N/A N/A N/A 1.87 .75 Pepper, 2016 1 N/A N/A N/A N/A 21.4 0 Romero, 2013 12 N/A N/A 71.5 N/A 7.46 2.99 Schraibman, 2014 12 N/A N/A N/A N/A 0 0 Vilallonga, 2013 12 N/A N/A 66 N/A 1 1 Endoscopic Sleeve Gastroplasty Abu Dayyeh, 2022 24 N/A N/A N/A 41.0% ± 32.0 11.7 3.90 Abu Dayyeh, 2017 20 N/A N/A N/A N/A 100 0 Alexandre, 2023 12 N/A N/A 42.9 ± 25.6% N/A 0 0 Alqahtani, 2023 6 n = 443 12 n = 377 24 n = 197 36 n = 163 N/A 67.5 ± 31.9 88.0 ± 27.8 87.3 ± 24.5 25.2 2.59 Alqahtani, 2019 1 n = 814 3 n = 689 6 n = 369 9 n = 291 12 n = 216 18 n = 54 49.3 ± 42.5 64.3 ± 56.2 67.5 ± 52.3 N/A 2.70 1.60 Barrichello, 2019 12 N/A N/A 59.41% ± 25.69% N/A 2.07 1.55 Correia, 2023 1 n = 73 3 n = 52 36.3 ± 11.35%" N/A N/A N/A 20.5 0 Fayad, 2019 6 N/A N/A N/A N/A 5.56 0 Lopez-Nava, 2017 1 (n = 143) 6 (n = 133) 12 (n = 64) 24 (n = 28) N/A 47.8 ± 29.4 52.6 ± 31.3 60.4 ± 31.1 0 0 Maselli, 2023 3 n = 312 6 n = 233 12 n = 151 15 n = 112 24 n = 112 36 n = 15 29.5 ± 9.6 39.2 ± 12.7 49.6 ± 15.1 49.4 ± 16.7 .50 0 Maselli, 2021 12 N/A N/A 47.6% ± 26.6% N/A 11.0 0 Morales, 2018 12 n = 148 18 n = 72 N/A N/A 75.4 ± 85 N/A 1.35 0 Sartoretto, 2018 1(n = 93) 3(n = 82 6(n = 52) 39.9 ± 17.3 50.3 ± 22.4 N/A N/A 2.68 0 Table 5 %EWL at different intervals. Preop BMI 1 month post op %EWL 3 months post op %EWL 6 months post op %EWL 12 months post op %EWL 18 months post op %EWL ESG mean ± SD 35.20 ± 4.29 36.29 ± 30.94 42.58 ± 33.9 58.32 ± 38.2 67.21 ± 41.58 73.01 ± 48.7 RSG mean ± SD 47.81 + 8.00 16.56 ± 8.6 25.21 ± 10.08 42.97 ± 9.67 65.51 ± 22.52 51.26 Table 4 . Post-operative outcomes of each study 9 – 32 Table 5 . %EWL at different intervals. Table 6 . P-values for RSG. Table 6 P-values for RSG. Preop BMI Diabetes (1 or 2) Hypertension Sleep Apnea P-value 0.93 0.16 0.06 0.53 Statistical Analysis Results Due to inconsistencies across studies, mainly variable increments of post-op follow up time, we focused on initial %EWL values for our statistical analysis as a success indicator. Using a multiple regression model with %EWL as the dependent variable and pre-operative BMI and comorbidities as independent variables, RSG studies showed no significant correlations between pre-operative BMI and comorbidities affecting %EWL at an alpha level of 0.05, as depicted in Fig. 3. However, at a 0.1 alpha level, a minor correlation between %EWL and hypertension emerged with a p-value of 0.06 (Fig. 2). In contrast, ESG studies revealed a significant correlation between pre-operative BMI and %EWL, with a p-value of 0.03, shown in Fig. 4. No correlation was found when comparing hospital stay, operative time, and complication rate. Figure 2. %EWL vs hypertension correlation for RSG Figure 3. %EWL vs pre-operative BMI correlation for RSG Figure 4. %EWL vs pre-operative BMI correlation for ESG Discussion This systematic review and comparison has shown that both RSG and ESG are effective and safe bariatric procedures. The %EWL for RSG patients was higher than ESG patients with each postoperative month check, however this difference was not statistically significant. Additionally, the variability in weight loss outcomes was more pronounced in ESG patients, as indicated by the larger standard deviation for %EWL across all time points. A significant difference between the two procedures lies in hospital stay, with ESG patients benefiting from considerably shorter hospital stays. Fayad et al. reported the shortest hospital stay with a length of only 0.34 days. This disparity primarily stems from ESG's minimally invasive nature, which eliminates the need for hospitalization. By avoiding the complexities of inpatient hospitalization, ESG simplifies the postoperative care process, allowing patients to commence their recovery with minimal hospital oversight. This aspect of ESG not only underscores its efficiency in facilitating patient recovery, but also highlights its potential to reduce healthcare costs associated with prolonged hospital stays. 33 , 34 Furthermore, the expedited discharge process associated with ESG can significantly enhance patient satisfaction by allowing individuals to return to their daily routines sooner. In our statistical analysis, the ESG studies showed a significant correlation between pre-operative BMI and %EWL, with a p-value of 0.03. Conversely, RSG studies revealed no significant correlation, indicated by a p-value of 0.93. This raises questions about the influence of pre-operative BMI on success rates between the two procedures. Although correlation does not imply causation, the variance might be attributed to operational differences: RSG typically involves a single surgeon, potentially leading to more consistent outcomes, unlike ESG, which often involves multiple surgeons, gastroenterologists, and assistants, possibly introducing variability in procedural success. Additionally, patients that underwent RSG exhibited a higher average preoperative BMI compared to those who underwent ESG. This distinction likely stems from the lower-risk patient population that is given ESG treatment. Patients with lower BMIs and fewer comorbidities are oftentimes better candidates for ESG treatment than higher-risk patients. This observation is supported by Fayad et al., who found in their comparative review that ESG patients presented with significantly fewer comorbidities at baseline than those undergoing Laparoscopic Sleeve Gastrectomy. 27 Given that individuals with higher BMI are more susceptible to surgical complications, RSG, performed under complete anesthesia, emerges as a more suitable option for this demographic. 11 , 19 , 35 This rationale aligns with the observation from reviewed studies that RSG patients typically present with a greater number of comorbidities than their ESG counterparts. 11 The necessity of complete anesthesia for patients with comorbidities—deemed higher-risk—underscores the preference for RSG in such cases. Furthermore, the prevalence of comorbidities among RSG patients may be linked to the procedure's extensive anatomical modifications, potentially offering superior mitigation of these health issues compared to ESG. Thus, for patients on the higher end of the BMI scale, RSG is the preferred intervention, while ESG would be preferred for less extreme cases. The difference in BMI between the two groups, as indicated by the p-value obtained in this study, reinforces RSG's suitability for higher BMI patients. However, it's important to note that recent studies have highlighted the efficacy of ESG even among high-BMI patients. Maselli et al. presented findings from a cohort of 404 class III obesity patients undergoing ESG, illustrating that with ongoing nutritional support, ESG could induce sustained weight loss in adults with severe obesity. 5 Similarly, Lopez-Nava et al. documented a 20.5% total body weight loss (TBWL) at one year in a study involving 146 patients with morbid obesity treated with ESG. 36 These studies suggest that the initial year post-ESG sees the most significant weight loss, with subsequent years focusing on maintaining the achieved weight reduction. 5 , 36 This evidence underscores the potential of ESG as a viable option for managing obesity in patients across a broad spectrum of BMI categories, challenging the traditional preference for RSG in higher-risk individuals. This systematic review faces several critical limitations. Firstly, the absence of randomized controlled trials introduces potential biases in data extraction, though retrospective, and prospective studies do offer valuable clinical insights. This study’s sample size may not have been large enough to produce robust data. Our selection criteria excluded studies published before 2010, large database analyses, and non-English language research, further limiting our study pool. Dependence on published data, without access to raw, individual-level details, also hindered our analysis. Additionally, inherent differences in study populations and methodologies introduced confounding variables that were difficult to control for in our comparative analysis. Finally, the limitations encountered in this comparative review mirror those inherent in the included studies. Conclusion Robotic Sleeve Gastrectomy and Endoscopic Sleeve Gastroplasty are both procedures that offer effective and safe options for the management of morbid obesity. Our analysis highlighted that while ESG typically results in shorter operative times and hospital stays, it is associated with a higher complication rate compared to RSG. Despite these differences, both procedures demonstrate significant potential in weight loss efficacy, underscoring the importance of patient-specific considerations in selecting the appropriate surgical intervention. The findings from this review should be interpreted in light of its limitations, including the absence of randomized controlled trials and potential biases inherent in the included studies. Future research should focus on larger, randomized trials to provide more definitive evidence regarding the comparative efficacy and safety of these procedures. Such studies would greatly contribute to optimizing bariatric surgery strategies, enhancing patient outcomes, and broadening the options available to individuals struggling with obesity. Declarations Funding The authors declare that no external funding or financial support was received from any organization, institution, or individual for the research, authorship, or publication of this article. All work was conducted independently without any financial incentives or conflicts of interest. Author Contribution Y.A. conceptualized the study, curated data, conducted the investigation, developed the methodology, administered the project, supervised the work, validated the findings, and wrote the original draft. T.E. contributed to conceptualization, data curation, and writing of the original draft. R.R. performed data curation, conducted statistical analysis, and contributed to writing through review and editing. Y.S. was responsible for data curation and statistical analysis. R.P. contributed to data curation, investigation, and writing the original draft. F.S. contributed to data curation, investigation, and writing through review and editing. D.A. was involved in writing through review and editing. V.S. contributed to data curation and investigation. F.M. and A.T. provided validation and writing through review and editing. All authors reviewed the manuscript. Acknowledgement We would like to thank Temple University College of Science and Technology for their unwavering support and commitment to research. References Maselli DB, Camilleri M. Effects of GLP-1 and Its Analogs on Gastric Physiology in Diabetes Mellitus and Obesity. Adv Exp Med Biol. 2021;1307:171-192. doi:10.1007/5584_2020_496 KREMEN AJ, LINNER JH, NELSON CH. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954;140(3):439-448. doi:10.1097/00000658-195409000-00018 O'Brien PE, Dixon JB, Brown W, et al. The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg. 2002;12(5):652-660. doi:10.1381/096089202321019639 Shin HJ, Yoo HK, Lee JH, Lee SR, Jeong K, Moon HS. Robotic single-port surgery using the da Vinci SP® surgical system for benign gynecologic disease: A preliminary report. Taiwan J Obstet Gynecol. 2020;59(2):243-247. doi:10.1016/j.tjog.2020.01.012 Maselli DB, Kucera A, Chapman CG, et al. The endoscopic bariatric patient: characteristics, beliefs, and fears. iGIE. 2024;3(1):82-91. doi:10.1016/j.igie.2023.12.004. Wei Y, Li P, Zhang S. From surgery to endoscopy: the evolution of the bariatric discipline. Chin Med J (Engl). 2022;135(20):2427-2435. Published 2022 Oct 20. doi:10.1097/CM9.0000000000002409 Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi:10.1371/journal.pmed.1000100 Haddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2022;18(2):e1230. Published 2022 Mar 27. doi:10.1002/cl2.1230 Ayloo S, Buchs NC, Addeo P, Bianco FM, Giulianotti PC. Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2011;21(4):295-299. doi:10.1089/lap.2010.0398 Bhatia P, Bindal V, Singh R, et al. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients. JSLS. 2014;18(3):e2014.00099. doi:10.4293/JSLS.2014.00099 Diamantis T, Alexandrou A, Nikiteas N, Giannopoulos A, Papalambros E. Initial experience with robotic sleeve gastrectomy for morbid obesity. Obes Surg. 2011;21(8):1172-1179. doi:10.1007/s11695-010-0242-8 Ecker BL, Maduka R, Ramdon A, Dempsey DT, Dumon KR, Williams NN. Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases. Surg Obes Relat Dis. 2016;12(2):313-320. doi:10.1016/j.soard.2015.05.011 Elli E, Gonzalez-Heredia R, Sarvepalli S, Masrur M. Laparoscopic and robotic sleeve gastrectomy: short- and long-term results. Obes Surg. 2015;25(6):967-974. doi:10.1007/s11695-014-1499-0 Kannan U, Ecker BL, Choudhury R, Dempsey DT, Williams NN, Dumon KR. Laparoscopic hand-assisted versus robotic-assisted laparoscopic sleeve gastrectomy: experience of 103 consecutive cases. Surg Obes Relat Dis. 2016;12(1):94-99. doi:10.1016/j.soard.2015.07.011 Moon RC, Stephenson D, Royall NA, Teixeira AF, Jawad MA. Robot-Assisted Versus Laparoscopic Sleeve Gastrectomy: Learning Curve, Perioperative, and Short-Term Outcomes. Obes Surg. 2016;26(10):2463-2468. doi:10.1007/s11695-016-2131-2 Pepper VK, Rager TM, Diefenbach KA, Raval MV, Teich S, Michalsky MP. Robotic vs. Laparoscopic Sleeve Gastrectomy in Adolescents; Reality or Hype. Obes Surg. 2016;26(8):1912-1917. doi:10.1007/s11695-015-2029-4 Romero RJ, Kosanovic R, Rabaza JR, et al. Robotic sleeve gastrectomy: experience of 134 cases and comparison with a systematic review of the laparoscopic approach. Obes Surg. 2013;23(11):1743-1752. doi:10.1007/s11695-013-1004-1 Schraibman V, Macedo AL, Epstein MG, et al. Comparison of the morbidity, weight loss, and relative costs between robotic and laparoscopic sleeve gastrectomy for the treatment of obesity in Brazil. Obes Surg. 2014;24(9):1420-1424. doi:10.1007/s11695-014-1239-5 Vilallonga R, Fort JM, Caubet E, Gonzalez O, Armengol M. Robotic sleeve gastrectomy versus laparoscopic sleeve gastrectomy: a comparative study with 200 patients. Obes Surg. 2013;23(10):1501-1507. doi:10.1007/s11695-013-1039-3 Abu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet. 2022;400(10350):441-451. doi:10.1016/S0140-6736(22)01280-6. Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals. Clin Gastroenterol Hepatol. 2017;15(1):37-43.e1. doi:10.1016/j.cgh.2015.12.030 Alexandre F, Lapergola A, Vannucci M, et al. Endoscopic management of obesity: Impact of endoscopic sleeve gastroplasty on weight loss and co-morbidities at six months and one year. J Visc Surg. 2023;160(2S):S38-S46. doi:10.1016/j.jviscsurg.2022.12.003 Alqahtani AR, Alqahtani O, Abdurabu H, et al. Endoscopic Sleeve Gastroplasty in Those With a Body Mass Index of 27-30. Am J Gastroenterol. 2023;118(10):1807-1811. doi:10.14309/ajg.0000000000002476 Alqahtani A, Al-Darwish A, Mahmoud AE, Alqahtani YA, Elahmedi M. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc. 2019;89(6):1132-1138. doi:10.1016/j.gie.2018.12.012 Barrichello S, Hourneaux de Moura DT, Hourneaux de Moura EG, et al. Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study. Gastrointest Endosc. 2019;90(5):770-780. doi:10.1016/j.gie.2019.06.013 Correia V, Maria B, Paulino A, et al. Endoscopic sleeve gastroplasty: early results of a minimally invasive procedure in patients with obesity. Surg Endosc. 2023;37(4):3215-3223. doi:10.1007/s00464-023-09982-z Fayad L, Adam A, Schweitzer M, et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc. 2019;89(4):782-788. doi:10.1016/j.gie.2018.08.030 Lopez-Nava G, Galvão MP, Bautista-Castaño I, Fernandez-Corbelle JP, Trell M, Lopez N. ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE. Arq Bras Cir Dig. 2017;30(1):18-20. doi:10.1590/0102-6720201700010006 Maselli DB, Hoff AC, Kucera A, et al. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc. 2023;15(6):469-479. doi:10.4253/wjge.v15.i6.469 Maselli DB, Alqahtani AR, Abu Dayyeh BK, et al. Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study. Gastrointest Endosc. 2021;93(1):122-130. doi:10.1016/j.gie.2020.05.028 Morales J, Crespo Pérez L, Marques A, et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc. 2018;32(9):3936-3942. doi:10.1007/s00464-018-6133-0 Sartoretto A, Sui Z, Hill C, et al. Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study. Obes Surg. 2018;28(7):1812-1821. doi:10.1007/s11695-018-3135-x Sharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy. 2015;47(2):164-166. doi:10.1055/s-0034-1390773 Sharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients. Clin Gastroenterol Hepatol. 2017;15(4):504-510. doi:10.1016/j.cgh.2016.12.012 Badaoui JN, Maroun JW, Oyefule OO, et al. Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m 2. Surg Laparosc Endosc Percutan Tech. 2022;32(4):466-471. Published 2022 Aug 1. doi:10.1097/SLE.0000000000001063 Lopez-Nava G, Laster J, Negi A, Fook-Chong S, Bautista-Castaño I, Asokkumar R. Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?. Surg Endosc. 2022;36(1):352-360. doi:10.1007/s00464-021-08289-1 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5040568","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":369208176,"identity":"2cb79a00-548c-493e-bafa-8321af513234","order_by":0,"name":"Yusuf-Zain 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University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Vijay","middleName":"","lastName":"Sivan","suffix":""},{"id":369208184,"identity":"98b279cd-a8b9-41de-88a1-87ec8fa67620","order_by":8,"name":"Florencia Marizcurena","email":"","orcid":"","institution":"National University of Córdoba","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Florencia","middleName":"","lastName":"Marizcurena","suffix":""},{"id":369208185,"identity":"51376bfc-4749-491d-a081-b1dd9e08aba4","order_by":9,"name":"Aley Tohamy","email":"","orcid":"","institution":"Mercy Fitzgerald Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aley","middleName":"","lastName":"Tohamy","suffix":""}],"badges":[],"createdAt":"2024-09-05 22:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5040568/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5040568/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":67260146,"identity":"58e0209e-7b73-4d2b-a805-25b7bff2bb15","added_by":"auto","created_at":"2024-10-23 05:57:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":49750,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA diagram\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5040568/v1/3bae0dc9ee4c7901f19d51c7.png"},{"id":67260150,"identity":"318fb54b-2036-441f-9683-e481f080676c","added_by":"auto","created_at":"2024-10-23 05:57:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":153240,"visible":true,"origin":"","legend":"\u003cp\u003e%EWL vs hypertension correlation for RSG\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5040568/v1/1ba4fbfd9156684618c070e4.png"},{"id":67260858,"identity":"7c704bfd-dbc5-4814-b906-a155d82118c1","added_by":"auto","created_at":"2024-10-23 06:05:32","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":170603,"visible":true,"origin":"","legend":"\u003cp\u003e%EWL vs pre-operative BMI correlation for RSG\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5040568/v1/d94ba5418a39063e905e9861.png"},{"id":67260148,"identity":"fb21fbed-3cea-42be-b39f-f4c81fbf8411","added_by":"auto","created_at":"2024-10-23 05:57:32","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":205550,"visible":true,"origin":"","legend":"\u003cp\u003e%EWL vs pre-operative BMI correlation for ESG\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5040568/v1/34950720bc93e45cf8ce45e4.png"},{"id":67262131,"identity":"9e11892a-d807-4779-8d1b-b70eba26b9c7","added_by":"auto","created_at":"2024-10-23 06:13:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1543629,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5040568/v1/549f5817-0727-4a57-9be5-c9c455644190.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparing Minimally Invasive Bariatric Techniques: A Systematic Review of Robotic Sleeve Gastrectomy vs. Endoscopic Sleeve Gastroplasty","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAs obesity escalates into a global crisis, research increasingly points to bariatric surgery as a more effective intervention than traditional treatment methods, including lifestyle changes and pharmacotherapy.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Bariatric surgery began in 1954 with a simple small bowel bypass to reduce the absorptive capacity of the stomach.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e During the 1970s, the evolution from earlier forms of bariatric surgery pioneered by Kremen to stomach stapling marked a significant shift towards techniques more akin to those used in contemporary procedures. The advent of the BioEnterics\u0026reg; Lap-Band \u0026reg; system, quickly pushed the laparoscopic technique to the forefront of bariatric surgery.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile laparoscopic techniques are still the standard for bariatric procedures, the use of robotic-assisted surgery has become increasingly popular. These robotic surgeries, typically done with the da Vinci Surgical System, allow for minimally invasive procedures that provide improved precision and visualization for the surgeon.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e One of the more prominent robotic procedures to treat obesity is the robotic sleeve gastrectomy (RSG). Like the laparoscopic sleeve gastrectomy, RSG reduces the stomach size by ~\u0026thinsp;80% to limit the amount of food a patient can hold as well as alter stomach hormones to decrease appetite and increase satiety, promoting weight loss for the patient.\u003c/p\u003e \u003cp\u003eEndoscopic bariatric treatments have developed within the last decade, boasting higher patient acceptance due to the minimally invasive and anatomic-preserving nature of the procedures.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The most commonly practiced endoscopic bariatric treatments are intragastric balloons, endoscopic duodenal-jejunal bypass liners, and endoscopic sleeve gastroplasty (ESG). The pathophysiological mechanisms of endoscopic procedures are similar to those of surgical bariatric surgeries by limiting gastric capacity, reducing nutrient absorption, and facilitating the non-absorbed discharge of gastric contents.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In this study, we aim to summarize the existing literature and compare surgical outcomes for RSG and ESG.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eLiterature Search\u003c/h2\u003e \u003cp\u003eThe article selection process was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement in order to retrieve all the relevant articles within the known literature\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. The following keywords were used in every possible combination within Google Scholar, Pubmed/Medline, and Cochrane Library: \u0026ldquo;endoscopic sleeve gastroplasty,\u0026rdquo; \u0026ldquo;robotic sleeve gastrectomy,\u0026rdquo; and \u0026ldquo;sleeve gastrectomy\u0026rdquo;. All the studies were searched before October 23, 2023 and search queries were limited to only display articles written in the English language. Duplicate articles were identified and removed from our system.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eTo be eligible for selection within this systematic review, articles were required to meet the following criteria: (1) assessing the efficacy and safety of RSG and ESG in the treatment of morbid obesity, (2) prospective or retrospective studies, (3) published from 2010 to 2023, and (4) published in the English language. We excluded articles that met the following criteria: (1) large database studies, (2) individual case series, (3) abstracts, letters, or reviews without original data, and (4) studies with no reported outcomes of interest.\u003c/p\u003e \u003cp\u003eThe primary objective endpoints were %EWL (excess weight loss), operative time, length of stay, reoperation, complications, and conversion to open surgery.\u003c/p\u003e\n\u003ch3\u003eData Extraction\u003c/h3\u003e\n\u003cp\u003eEligible articles were reassessed by two independent reviewers to confirm all inclusion criteria were met. If any disagreement or discrepancy occurred in the studies, the two reviewers consulted the guarantor author. For each article, the following data was recorded: demographics (including number of patients, mean age, sex, comorbidities, and preoperative body mass index (BMI)); mean operative time; estimated blood loss; length of stay; reoperation; intraoperative and post-operative complications; conversion to open surgery; %EWL (excess weight loss) after 1, 3, 6, 12, 18 months; and comorbidity relief. For continuous outcomes, the mean, standard deviation, and number of patients were recorded. We calculated standard deviation using available data when it was not provided. Three independent reviewers ensured accurate data extraction.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eRegarding the categorical outcomes, the odds ratio (OR) and 95% confidence interval (CI) were calculated, based on the extracted data, by means of a fixed-effects model (Mantel-Haenszel statistical method), where the number of studies providing data was sufficient. OR\u0026thinsp;\u0026lt;\u0026thinsp;1 denoted that outcome was more frequent in the RSG group. Continuous outcomes were evaluated by means of weighted mean difference (WMD) with its 95% CI, using fixed-effects and random-effects (inverse variance statistical method) models, appropriately to calculate pooled effect estimates. In cases where WMD\u0026thinsp;\u0026lt;\u0026thinsp;0, values in the RSG group were higher. Between studies, heterogeneity was assessed using Cochran\u0026rsquo;s Q statistic and by estimation.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eArticle Selection Results\u003c/h2\u003e \u003cp\u003eOur literature review selected twenty-four studies from various countries including the United States, Brazil, India, Spain, Greece, Portugal, Saudi Arabia, and France, spanning from 2010 to October 2023. The key details of these articles are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The article selection process is shown below in Fig.\u0026nbsp;1.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst author, Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eRobotic Sleeve Gastrectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAyloo, 2011 \u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ Laparoendosc Adv Surg Tech A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiamantis, 2010 \u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGreece\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcker, 2016 \u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurg Obes Relat Dis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElli, 2014 \u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKannan, 2015 \u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurg Obes Relat Dis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoon, 2016 \u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePepper, 2016 \u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRomero, 2013 \u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchraibman, 2014 \u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVilallonga, 2013 \u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eEndoscopic Sleeve Gastroplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbu Dayyeh, 2022 \u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLancet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbu Dayyeh, 2017 \u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClin Gastroenterol Hepatol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlexandre, 2023 \u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJ Visc Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlqahtani, 2023 \u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAm J Gastroenterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlqahtani, 2019 \u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClin Endosc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSaudi Arabia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarrichello, 2019 \u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClin Endosc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil, United States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorreia, 2023 \u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurg Endosc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePortugal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFayad, 2019 \u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClin Endosc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLopez-Nava, 2017 \u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArq Bras Cir Dig\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaselli, 2023 \u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWGJE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil/United States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaselli, 2021 \u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClin Endosc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnited States, UAE, Saudi Arabia, Brazil\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorales, 2018 \u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurg Endosc\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSartoretto, 2018 \u003csup\u003e32\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObes Surg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustralia/United States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1.\u003c/b\u003e PRISMA diagram\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Characteristics of included studies\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient Demographics\u003c/h3\u003e\n\u003cp\u003eThis systematic review synthesized data from 24 studies, encompassing a total of 5259 patients, with 1182 undergoing Robotic Sleeve Gastrectomy (RSG) and 4077 undergoing Endoscopic Sleeve Gastroplasty (ESG). The demographic breakdown indicated 991 females and 4268 males, with ESG and RSG procedures being performed on 565 females and 3512 males, and 426 females and 755 males, respectively. The average age of patients was 37.49\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64 years for ESG and 42.79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.38 years for RSG. Furthermore, the average preoperative BMI was 34.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 for ESG patients and 47.81\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08 for RSG patients. Detailed patient demographics and intraoperative parameters for each individual study are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e, while aggregated data across all studies are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, offering a comprehensive overview of patient profiles and procedural specifics within this comparative analysis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntraoperative parameters of each study \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst author, Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean pre-op BMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLength of stay (days)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean operative time (min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntraoperativecomplication rate (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eConversion rate (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eRobotic Sleeve Gastrectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAyloo, 2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e135\u0026thinsp;\u0026plusmn;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhatia, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.36\u0026thinsp;\u0026plusmn;\u0026thinsp;.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e116.6\u0026thinsp;\u0026plusmn;\u0026thinsp;48.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiamantis, 2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95.5\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcker, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.6\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e96.4\u0026thinsp;\u0026plusmn;\u0026thinsp;24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElli, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110.6\u0026thinsp;\u0026plusmn;\u0026thinsp;48.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKannan, 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoon, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePepper, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.8125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e131.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRomero, 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e106.6\u0026thinsp;\u0026plusmn;\u0026thinsp;48.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchraibman, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVilallonga, 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e108\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003eEndoscopic Sleeve Gastroplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbu Dayyeh, 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbu Dayyeh, 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlexandre, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e38\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlqahtani, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlqahtani, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarrichello, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e76\u0026thinsp;\u0026plusmn;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorreia, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e83\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFayad, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.34\u0026thinsp;\u0026plusmn;\u0026thinsp;.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLopez-Nava, 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaselli, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaselli, 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorales, 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.52\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.11\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45\u0026thinsp;\u0026plusmn;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSartoretto, 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics across all studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerioperative data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eESG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRSG\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.52\u0026thinsp;\u0026plusmn;\u0026thinsp;9.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.79\u0026thinsp;\u0026plusmn;\u0026thinsp;11.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale/Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e565/3512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e426/755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op BMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47.81\u0026thinsp;\u0026plusmn;\u0026thinsp;8.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor Comorbidities\u003c/p\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003cp\u003eGERD\u003c/p\u003e \u003cp\u003eSleep Apnea\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235 Patients\u003c/p\u003e \u003cp\u003e361 Patients\u003c/p\u003e \u003cp\u003e87 Patients\u003c/p\u003e \u003cp\u003e90 Patients\u003c/p\u003e \u003cp\u003e285 Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304 Patients\u003c/p\u003e \u003cp\u003e462 Patients\u003c/p\u003e \u003cp\u003e11 Patients\u003c/p\u003e \u003cp\u003e405 Patients\u003c/p\u003e \u003cp\u003e390 Patients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation Time (minutes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63.10\u0026thinsp;\u0026plusmn;\u0026thinsp;22.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104.93\u0026thinsp;\u0026plusmn;\u0026thinsp;32.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of Stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Intraoperative parameters of each study \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Patient characteristics across all studies\u003c/p\u003e \u003cp\u003eThe review also focused on major comorbidities, including diabetes, hypertension, Gastroesophageal Reflux Disease (GERD), and sleep apnea, although not all studies provided details on these conditions. In total, among the patients with disclosed comorbidities, 539 had diabetes, 823 had hypertension, 98 had GERD, 495 had sleep apnea, and 675 had other comorbidities. Specifically, for ESG, among 1058 patients with known comorbidities, 22% were diagnosed with diabetes, 34% with hypertension, 8% with GERD, 9% with sleep apnea, and 27% with other conditions. For RSG, among 1572 patients with disclosed comorbidities, 19% had diabetes, 29% had hypertension, 1% had GERD, 26% had sleep apnea, and 25% had other comorbidities.\u003c/p\u003e\n\u003ch3\u003eClinical Outcomes\u003c/h3\u003e\n\u003cp\u003eIn this systematic review, we evaluated five critical factors to discern the differences between ESG and RSG: percent excess weight loss (%EWL) over time, postoperative complication rates, reoperation rates, rates of conversion to open surgery, average hospital length of stay, and mean operative times. The %EWL observed in ESG patients at 1, 3, 6, 12, and 18 months post-procedure were 36.29\u0026thinsp;\u0026plusmn;\u0026thinsp;31.60, 42.58\u0026thinsp;\u0026plusmn;\u0026thinsp;35.02, 58.32\u0026thinsp;\u0026plusmn;\u0026thinsp;39.80, 67.21\u0026thinsp;\u0026plusmn;\u0026thinsp;44.50, and 65.63\u0026thinsp;\u0026plusmn;\u0026thinsp;54.81, respectively. Conversely, RSG patients reported %EWL of 16.56\u0026thinsp;\u0026plusmn;\u0026thinsp;8.67, 25.21\u0026thinsp;\u0026plusmn;\u0026thinsp;10.73, 43.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.04, 65.51\u0026thinsp;\u0026plusmn;\u0026thinsp;23.50, and 51.26 at corresponding intervals, showing that ESG patients consistently achieved higher %EWL at all monitored stages.\u003c/p\u003e \u003cp\u003eA total of 330 postoperative complications were documented, with 288 occurring in ESG patients and 42 in RSG patients. The ESG cohort had a reoperation rate of 1.35% and a conversion rate to open surgery of 0.025%, while the RSG cohort exhibited a reoperation rate of 0.76% and a conversion rate to open surgery of 0.085%. Furthermore, the average hospital stay was significantly shorter for ESG patients at 0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73 days, compared to 2.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89 days for RSG patients, emphasizing ESG's minimally invasive approach.\u003c/p\u003e \u003cp\u003eAn important operational distinction was found in the mean operative times: ESG procedures averaged 68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.66 minutes, while RSG procedures took longer, with an average of 104.93\u0026thinsp;\u0026plusmn;\u0026thinsp;33.66 minutes. This indicates that overall, the RSG procedure is more time-consuming, reflecting the complexity and technical demands of robotic surgery compared to the more streamlined ESG process.\u003c/p\u003e \u003cp\u003eThe detailed post-operative outcomes for each individual study are compiled in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, while a comprehensive overview of outcomes across all analyzed studies is presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. This structured presentation of data provides a transparent comparison of the efficacy, safety, and operational efficiencies of ESG and RSG, contributing to a nuanced understanding of their relative benefits and challenges in managing obesity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost-operative outcomes of each study \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Author, Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up period (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%EWL \u003c/p\u003e \u003cp\u003e(3 month)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%EWL \u003c/p\u003e \u003cp\u003e(6 month)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%EWL \u003c/p\u003e \u003cp\u003e(12 month)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%EWL \u003c/p\u003e \u003cp\u003e(24 month)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eReoperation Rate (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePostoperative complications (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eRobotic Sleeve Gastrectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAyloo, 2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBhatia, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiamantis, 2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e3 (n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003cp\u003e6 (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003cp\u003e12 (n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65.5\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEcker, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElli, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (n\u0026thinsp;=\u0026thinsp;71),\u003c/p\u003e \u003cp\u003e6 (n\u0026thinsp;=\u0026thinsp;69),\u003c/p\u003e \u003cp\u003e9 (n\u0026thinsp;=\u0026thinsp;44),\u003c/p\u003e \u003cp\u003e12 (n\u0026thinsp;=\u0026thinsp;38),\u003c/p\u003e \u003cp\u003e18 (n\u0026thinsp;=\u0026thinsp;23),\u003c/p\u003e \u003cp\u003e24 (n\u0026thinsp;=\u0026thinsp;23),\u003c/p\u003e \u003cp\u003e36 (n\u0026thinsp;=\u0026thinsp;15),\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;36 (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKannan, 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (n\u0026thinsp;=\u0026thinsp;43),\u003c/p\u003e \u003cp\u003e6 (n\u0026thinsp;=\u0026thinsp;30),\u003c/p\u003e \u003cp\u003e12 (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;11.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.0\u0026thinsp;\u0026plusmn;\u0026thinsp;20.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoon, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePepper, 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRomero, 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchraibman, 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVilallonga, 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eEndoscopic Sleeve Gastroplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbu Dayyeh, 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41.0% \u0026plusmn; 32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbu Dayyeh, 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlexandre, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.9\u0026thinsp;\u0026plusmn;\u0026thinsp;25.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlqahtani, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 n\u0026thinsp;=\u0026thinsp;443\u003c/p\u003e \u003cp\u003e12 n\u0026thinsp;=\u0026thinsp;377\u003c/p\u003e \u003cp\u003e24 n\u0026thinsp;=\u0026thinsp;197\u003c/p\u003e \u003cp\u003e36 n\u0026thinsp;=\u0026thinsp;163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.5\u0026thinsp;\u0026plusmn;\u0026thinsp;31.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.0\u0026thinsp;\u0026plusmn;\u0026thinsp;27.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.3\u0026thinsp;\u0026plusmn;\u0026thinsp;24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlqahtani, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 n\u0026thinsp;=\u0026thinsp;814\u003c/p\u003e \u003cp\u003e3 n\u0026thinsp;=\u0026thinsp;689\u003c/p\u003e \u003cp\u003e6 n\u0026thinsp;=\u0026thinsp;369\u003c/p\u003e \u003cp\u003e9 n\u0026thinsp;=\u0026thinsp;291\u003c/p\u003e \u003cp\u003e12 n\u0026thinsp;=\u0026thinsp;216\u003c/p\u003e \u003cp\u003e18 n\u0026thinsp;=\u0026thinsp;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.3\u0026thinsp;\u0026plusmn;\u0026thinsp;42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.3\u0026thinsp;\u0026plusmn;\u0026thinsp;56.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.5\u0026thinsp;\u0026plusmn;\u0026thinsp;52.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarrichello, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.41% \u0026plusmn; 25.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorreia, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 n\u0026thinsp;=\u0026thinsp;73\u003c/p\u003e \u003cp\u003e3 n\u0026thinsp;=\u0026thinsp;52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.35%\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFayad, 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLopez-Nava, 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (n\u0026thinsp;=\u0026thinsp;143)\u003c/p\u003e \u003cp\u003e6 (n\u0026thinsp;=\u0026thinsp;133)\u003c/p\u003e \u003cp\u003e12 (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003cp\u003e24 (n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.8\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e52.6\u0026thinsp;\u0026plusmn;\u0026thinsp;31.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.4\u0026thinsp;\u0026plusmn;\u0026thinsp;31.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaselli, 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 n\u0026thinsp;=\u0026thinsp;312\u003c/p\u003e \u003cp\u003e6 n\u0026thinsp;=\u0026thinsp;233\u003c/p\u003e \u003cp\u003e12 n\u0026thinsp;=\u0026thinsp;151\u003c/p\u003e \u003cp\u003e15 n\u0026thinsp;=\u0026thinsp;112\u003c/p\u003e \u003cp\u003e24 n\u0026thinsp;=\u0026thinsp;112\u003c/p\u003e \u003cp\u003e36 n\u0026thinsp;=\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.2\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49.4\u0026thinsp;\u0026plusmn;\u0026thinsp;16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaselli, 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.6% \u0026plusmn; 26.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMorales, 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 n\u0026thinsp;=\u0026thinsp;148\u003c/p\u003e \u003cp\u003e18 n\u0026thinsp;=\u0026thinsp;72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75.4\u0026thinsp;\u0026plusmn;\u0026thinsp;85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSartoretto, 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(n\u0026thinsp;=\u0026thinsp;93)\u003c/p\u003e \u003cp\u003e3(n\u0026thinsp;=\u0026thinsp;82\u003c/p\u003e \u003cp\u003e6(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.9\u0026thinsp;\u0026plusmn;\u0026thinsp;17.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;22.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e%EWL at different intervals.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreop\u003c/p\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 month post op %EWL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 months post op\u003c/p\u003e \u003cp\u003e%EWL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 months post op\u003c/p\u003e \u003cp\u003e%EWL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 months post op\u003c/p\u003e \u003cp\u003e%EWL\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18 months post op\u003c/p\u003e \u003cp\u003e%EWL\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eESG\u003c/p\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e36.29\u0026thinsp;\u0026plusmn;\u0026thinsp;30.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e42.58\u0026thinsp;\u0026plusmn;\u0026thinsp;33.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e58.32\u0026thinsp;\u0026plusmn;\u0026thinsp;38.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e67.21\u0026thinsp;\u0026plusmn;\u0026thinsp;41.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e73.01\u0026thinsp;\u0026plusmn;\u0026thinsp;48.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRSG\u003c/p\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.81\u0026thinsp;+\u0026thinsp;8.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.56\u0026thinsp;\u0026plusmn;\u0026thinsp;8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e25.21\u0026thinsp;\u0026plusmn;\u0026thinsp;10.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c5\"\u003e \u003cp\u003e42.97\u0026thinsp;\u0026plusmn;\u0026thinsp;9.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e65.51\u0026thinsp;\u0026plusmn;\u0026thinsp;22.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Post-operative outcomes of each study \u003csup\u003e\u003cspan additionalcitationids=\"CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28 CR29 CR30 CR31\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. %EWL at different intervals.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. P-values for RSG.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eP-values for RSG.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreop BMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDiabetes (1 or 2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSleep Apnea\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis Results\u003c/h2\u003e \u003cp\u003eDue to inconsistencies across studies, mainly variable increments of post-op follow up time, we focused on initial %EWL values for our statistical analysis as a success indicator. Using a multiple regression model with %EWL as the dependent variable and pre-operative BMI and comorbidities as independent variables, RSG studies showed no significant correlations between pre-operative BMI and comorbidities affecting %EWL at an alpha level of 0.05, as depicted in Fig.\u0026nbsp;3. However, at a 0.1 alpha level, a minor correlation between %EWL and hypertension emerged with a p-value of 0.06 (Fig.\u0026nbsp;2). In contrast, ESG studies revealed a significant correlation between pre-operative BMI and %EWL, with a p-value of 0.03, shown in Fig.\u0026nbsp;4. No correlation was found when comparing hospital stay, operative time, and complication rate.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 2.\u003c/b\u003e %EWL vs hypertension correlation for RSG\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 3.\u003c/b\u003e %EWL vs pre-operative BMI correlation for RSG\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 4.\u003c/b\u003e %EWL vs pre-operative BMI correlation for ESG\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis systematic review and comparison has shown that both RSG and ESG are effective and safe bariatric procedures. The %EWL for RSG patients was higher than ESG patients with each postoperative month check, however this difference was not statistically significant. Additionally, the variability in weight loss outcomes was more pronounced in ESG patients, as indicated by the larger standard deviation for %EWL across all time points.\u003c/p\u003e \u003cp\u003eA significant difference between the two procedures lies in hospital stay, with ESG patients benefiting from considerably shorter hospital stays. Fayad et al. reported the shortest hospital stay with a length of only 0.34 days. This disparity primarily stems from ESG's minimally invasive nature, which eliminates the need for hospitalization. By avoiding the complexities of inpatient hospitalization, ESG simplifies the postoperative care process, allowing patients to commence their recovery with minimal hospital oversight. This aspect of ESG not only underscores its efficiency in facilitating patient recovery, but also highlights its potential to reduce healthcare costs associated with prolonged hospital stays.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Furthermore, the expedited discharge process associated with ESG can significantly enhance patient satisfaction by allowing individuals to return to their daily routines sooner.\u003c/p\u003e \u003cp\u003eIn our statistical analysis, the ESG studies showed a significant correlation between pre-operative BMI and %EWL, with a p-value of 0.03. Conversely, RSG studies revealed no significant correlation, indicated by a p-value of 0.93. This raises questions about the influence of pre-operative BMI on success rates between the two procedures. Although correlation does not imply causation, the variance might be attributed to operational differences: RSG typically involves a single surgeon, potentially leading to more consistent outcomes, unlike ESG, which often involves multiple surgeons, gastroenterologists, and assistants, possibly introducing variability in procedural success.\u003c/p\u003e \u003cp\u003eAdditionally, patients that underwent RSG exhibited a higher average preoperative BMI compared to those who underwent ESG. This distinction likely stems from the lower-risk patient population that is given ESG treatment. Patients with lower BMIs and fewer comorbidities are oftentimes better candidates for ESG treatment than higher-risk patients. This observation is supported by Fayad et al., who found in their comparative review that ESG patients presented with significantly fewer comorbidities at baseline than those undergoing Laparoscopic Sleeve Gastrectomy.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Given that individuals with higher BMI are more susceptible to surgical complications, RSG, performed under complete anesthesia, emerges as a more suitable option for this demographic.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e This rationale aligns with the observation from reviewed studies that RSG patients typically present with a greater number of comorbidities than their ESG counterparts.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The necessity of complete anesthesia for patients with comorbidities\u0026mdash;deemed higher-risk\u0026mdash;underscores the preference for RSG in such cases. Furthermore, the prevalence of comorbidities among RSG patients may be linked to the procedure's extensive anatomical modifications, potentially offering superior mitigation of these health issues compared to ESG. Thus, for patients on the higher end of the BMI scale, RSG is the preferred intervention, while ESG would be preferred for less extreme cases. The difference in BMI between the two groups, as indicated by the p-value obtained in this study, reinforces RSG's suitability for higher BMI patients.\u003c/p\u003e \u003cp\u003eHowever, it's important to note that recent studies have highlighted the efficacy of ESG even among high-BMI patients. Maselli et al. presented findings from a cohort of 404 class III obesity patients undergoing ESG, illustrating that with ongoing nutritional support, ESG could induce sustained weight loss in adults with severe obesity.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Similarly, Lopez-Nava et al. documented a 20.5% total body weight loss (TBWL) at one year in a study involving 146 patients with morbid obesity treated with ESG.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e These studies suggest that the initial year post-ESG sees the most significant weight loss, with subsequent years focusing on maintaining the achieved weight reduction.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e This evidence underscores the potential of ESG as a viable option for managing obesity in patients across a broad spectrum of BMI categories, challenging the traditional preference for RSG in higher-risk individuals.\u003c/p\u003e \u003cp\u003eThis systematic review faces several critical limitations. Firstly, the absence of randomized controlled trials introduces potential biases in data extraction, though retrospective, and prospective studies do offer valuable clinical insights. This study\u0026rsquo;s sample size may not have been large enough to produce robust data. Our selection criteria excluded studies published before 2010, large database analyses, and non-English language research, further limiting our study pool. Dependence on published data, without access to raw, individual-level details, also hindered our analysis. Additionally, inherent differences in study populations and methodologies introduced confounding variables that were difficult to control for in our comparative analysis. Finally, the limitations encountered in this comparative review mirror those inherent in the included studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRobotic Sleeve Gastrectomy and Endoscopic Sleeve Gastroplasty are both procedures that offer effective and safe options for the management of morbid obesity. Our analysis highlighted that while ESG typically results in shorter operative times and hospital stays, it is associated with a higher complication rate compared to RSG. Despite these differences, both procedures demonstrate significant potential in weight loss efficacy, underscoring the importance of patient-specific considerations in selecting the appropriate surgical intervention.\u003c/p\u003e \u003cp\u003eThe findings from this review should be interpreted in light of its limitations, including the absence of randomized controlled trials and potential biases inherent in the included studies. Future research should focus on larger, randomized trials to provide more definitive evidence regarding the comparative efficacy and safety of these procedures. Such studies would greatly contribute to optimizing bariatric surgery strategies, enhancing patient outcomes, and broadening the options available to individuals struggling with obesity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare that no external funding or financial support was received from any organization, institution, or individual for the research, authorship, or publication of this article. All work was conducted independently without any financial incentives or conflicts of interest.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.A. conceptualized the study, curated data, conducted the investigation, developed the methodology, administered the project, supervised the work, validated the findings, and wrote the original draft. T.E. contributed to conceptualization, data curation, and writing of the original draft. R.R. performed data curation, conducted statistical analysis, and contributed to writing through review and editing. Y.S. was responsible for data curation and statistical analysis. R.P. contributed to data curation, investigation, and writing the original draft. F.S. contributed to data curation, investigation, and writing through review and editing. D.A. was involved in writing through review and editing. V.S. contributed to data curation and investigation. F.M. and A.T. provided validation and writing through review and editing. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank Temple University College of Science and Technology for their unwavering support and commitment to research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMaselli DB, Camilleri M. Effects of GLP-1 and Its Analogs on Gastric Physiology in Diabetes Mellitus and Obesity. Adv Exp Med Biol. 2021;1307:171-192. doi:10.1007/5584_2020_496\u003c/li\u003e\n \u003cli\u003eKREMEN AJ, LINNER JH, NELSON CH. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954;140(3):439-448. doi:10.1097/00000658-195409000-00018\u003c/li\u003e\n \u003cli\u003eO\u0026apos;Brien PE, Dixon JB, Brown W, et al. The laparoscopic adjustable gastric band (Lap-Band): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg. 2002;12(5):652-660. doi:10.1381/096089202321019639\u003c/li\u003e\n \u003cli\u003eShin HJ, Yoo HK, Lee JH, Lee SR, Jeong K, Moon HS. Robotic single-port surgery using the da Vinci SP\u0026reg; surgical system for benign gynecologic disease: A preliminary report. Taiwan J Obstet Gynecol. 2020;59(2):243-247. doi:10.1016/j.tjog.2020.01.012\u003c/li\u003e\n \u003cli\u003eMaselli DB, Kucera A, Chapman CG, et al. The endoscopic bariatric patient: characteristics, beliefs, and fears. iGIE. 2024;3(1):82-91. doi:10.1016/j.igie.2023.12.004.\u003c/li\u003e\n \u003cli\u003eWei Y, Li P, Zhang S. From surgery to endoscopy: the evolution of the bariatric discipline. Chin Med J (Engl). 2022;135(20):2427-2435. Published 2022 Oct 20. doi:10.1097/CM9.0000000000002409\u003c/li\u003e\n \u003cli\u003eLiberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi:10.1371/journal.pmed.1000100\u003c/li\u003e\n \u003cli\u003eHaddaway NR, Page MJ, Pritchard CC, McGuinness LA. PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis. Campbell Syst Rev. 2022;18(2):e1230. Published 2022 Mar 27. doi:10.1002/cl2.1230\u003c/li\u003e\n \u003cli\u003eAyloo S, Buchs NC, Addeo P, Bianco FM, Giulianotti PC. Robot-assisted sleeve gastrectomy for super-morbidly obese patients. J Laparoendosc Adv Surg Tech A. 2011;21(4):295-299. doi:10.1089/lap.2010.0398\u003c/li\u003e\n \u003cli\u003eBhatia P, Bindal V, Singh R, et al. Robot-assisted sleeve gastrectomy in morbidly obese versus super obese patients. JSLS. 2014;18(3):e2014.00099. doi:10.4293/JSLS.2014.00099\u003c/li\u003e\n \u003cli\u003eDiamantis T, Alexandrou A, Nikiteas N, Giannopoulos A, Papalambros E. Initial experience with robotic sleeve gastrectomy for morbid obesity. Obes Surg. 2011;21(8):1172-1179. doi:10.1007/s11695-010-0242-8\u003c/li\u003e\n \u003cli\u003eEcker BL, Maduka R, Ramdon A, Dempsey DT, Dumon KR, Williams NN. Resident education in robotic-assisted vertical sleeve gastrectomy: outcomes and cost-analysis of 411 consecutive cases. Surg Obes Relat Dis. 2016;12(2):313-320. doi:10.1016/j.soard.2015.05.011\u003c/li\u003e\n \u003cli\u003eElli E, Gonzalez-Heredia R, Sarvepalli S, Masrur M. Laparoscopic and robotic sleeve gastrectomy: short- and long-term results. Obes Surg. 2015;25(6):967-974. doi:10.1007/s11695-014-1499-0\u003c/li\u003e\n \u003cli\u003eKannan U, Ecker BL, Choudhury R, Dempsey DT, Williams NN, Dumon KR. Laparoscopic hand-assisted versus robotic-assisted laparoscopic sleeve gastrectomy: experience of 103 consecutive cases. Surg Obes Relat Dis. 2016;12(1):94-99. doi:10.1016/j.soard.2015.07.011\u003c/li\u003e\n \u003cli\u003eMoon RC, Stephenson D, Royall NA, Teixeira AF, Jawad MA. Robot-Assisted Versus Laparoscopic Sleeve Gastrectomy: Learning Curve, Perioperative, and Short-Term Outcomes. Obes Surg. 2016;26(10):2463-2468. doi:10.1007/s11695-016-2131-2\u003c/li\u003e\n \u003cli\u003ePepper VK, Rager TM, Diefenbach KA, Raval MV, Teich S, Michalsky MP. Robotic vs. Laparoscopic Sleeve Gastrectomy in Adolescents; Reality or Hype. Obes Surg. 2016;26(8):1912-1917. doi:10.1007/s11695-015-2029-4\u003c/li\u003e\n \u003cli\u003eRomero RJ, Kosanovic R, Rabaza JR, et al. Robotic sleeve gastrectomy: experience of 134 cases and comparison with a systematic review of the laparoscopic approach. Obes Surg. 2013;23(11):1743-1752. doi:10.1007/s11695-013-1004-1\u003c/li\u003e\n \u003cli\u003eSchraibman V, Macedo AL, Epstein MG, et al. Comparison of the morbidity, weight loss, and relative costs between robotic and laparoscopic sleeve gastrectomy for the treatment of obesity in Brazil. Obes Surg. 2014;24(9):1420-1424. doi:10.1007/s11695-014-1239-5\u003c/li\u003e\n \u003cli\u003eVilallonga R, Fort JM, Caubet E, Gonzalez O, Armengol M. Robotic sleeve gastrectomy versus laparoscopic sleeve gastrectomy: a comparative study with 200 patients. Obes Surg. 2013;23(10):1501-1507. doi:10.1007/s11695-013-1039-3\u003c/li\u003e\n \u003cli\u003eAbu Dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet. 2022;400(10350):441-451. doi:10.1016/S0140-6736(22)01280-6.\u003c/li\u003e\n \u003cli\u003eAbu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic Sleeve Gastroplasty Alters Gastric Physiology and Induces Loss of Body Weight in Obese Individuals. Clin Gastroenterol Hepatol. 2017;15(1):37-43.e1. doi:10.1016/j.cgh.2015.12.030\u003c/li\u003e\n \u003cli\u003eAlexandre F, Lapergola A, Vannucci M, et al. Endoscopic management of obesity: Impact of endoscopic sleeve gastroplasty on weight loss and co-morbidities at six months and one year. J Visc Surg. 2023;160(2S):S38-S46. doi:10.1016/j.jviscsurg.2022.12.003\u003c/li\u003e\n \u003cli\u003eAlqahtani AR, Alqahtani O, Abdurabu H, et al. Endoscopic Sleeve Gastroplasty in Those With a Body Mass Index of 27-30. Am J Gastroenterol. 2023;118(10):1807-1811. doi:10.14309/ajg.0000000000002476\u003c/li\u003e\n \u003cli\u003eAlqahtani A, Al-Darwish A, Mahmoud AE, Alqahtani YA, Elahmedi M. Short-term outcomes of endoscopic sleeve gastroplasty in 1000 consecutive patients. Gastrointest Endosc. 2019;89(6):1132-1138. doi:10.1016/j.gie.2018.12.012\u003c/li\u003e\n \u003cli\u003eBarrichello S, Hourneaux de Moura DT, Hourneaux de Moura EG, et al. Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study. Gastrointest Endosc. 2019;90(5):770-780. doi:10.1016/j.gie.2019.06.013\u003c/li\u003e\n \u003cli\u003eCorreia V, Maria B, Paulino A, et al. Endoscopic sleeve gastroplasty: early results of a minimally invasive procedure in patients with obesity. Surg Endosc. 2023;37(4):3215-3223. doi:10.1007/s00464-023-09982-z\u003c/li\u003e\n \u003cli\u003eFayad L, Adam A, Schweitzer M, et al. Endoscopic sleeve gastroplasty versus laparoscopic sleeve gastrectomy: a case-matched study. Gastrointest Endosc. 2019;89(4):782-788. doi:10.1016/j.gie.2018.08.030\u003c/li\u003e\n \u003cli\u003eLopez-Nava G, Galv\u0026atilde;o MP, Bautista-Casta\u0026ntilde;o I, Fernandez-Corbelle JP, Trell M, Lopez N. ENDOSCOPIC SLEEVE GASTROPLASTY FOR OBESITY TREATMENT: TWO YEARS OF EXPERIENCE. Arq Bras Cir Dig. 2017;30(1):18-20. doi:10.1590/0102-6720201700010006\u003c/li\u003e\n \u003cli\u003eMaselli DB, Hoff AC, Kucera A, et al. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc. 2023;15(6):469-479. doi:10.4253/wjge.v15.i6.469\u003c/li\u003e\n \u003cli\u003eMaselli DB, Alqahtani AR, Abu Dayyeh BK, et al. Revisional endoscopic sleeve gastroplasty of laparoscopic sleeve gastrectomy: an international, multicenter study. Gastrointest Endosc. 2021;93(1):122-130. doi:10.1016/j.gie.2020.05.028\u003c/li\u003e\n \u003cli\u003eMorales J, Crespo P\u0026eacute;rez L, Marques A, et al. Modified endoscopic gastroplasty for the treatment of obesity. Surg Endosc. 2018;32(9):3936-3942. doi:10.1007/s00464-018-6133-0\u003c/li\u003e\n \u003cli\u003eSartoretto A, Sui Z, Hill C, et al. Endoscopic Sleeve Gastroplasty (ESG) Is a Reproducible and Effective Endoscopic Bariatric Therapy Suitable for Widespread Clinical Adoption: a Large, International Multicenter Study. Obes Surg. 2018;28(7):1812-1821. doi:10.1007/s11695-018-3135-x\u003c/li\u003e\n \u003cli\u003eSharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy. 2015;47(2):164-166. doi:10.1055/s-0034-1390773\u003c/li\u003e\n \u003cli\u003eSharaiha RZ, Kumta NA, Saumoy M, et al. Endoscopic Sleeve Gastroplasty Significantly Reduces Body Mass Index and Metabolic Complications in Obese Patients. Clin Gastroenterol Hepatol. 2017;15(4):504-510. doi:10.1016/j.cgh.2016.12.012\u003c/li\u003e\n \u003cli\u003eBadaoui JN, Maroun JW, Oyefule OO, et al. Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI \u0026gt;50\u0026thinsp;kg/m 2. Surg Laparosc Endosc Percutan Tech. 2022;32(4):466-471. Published 2022 Aug 1. doi:10.1097/SLE.0000000000001063\u003c/li\u003e\n \u003cli\u003eLopez-Nava G, Laster J, Negi A, Fook-Chong S, Bautista-Casta\u0026ntilde;o I, Asokkumar R. Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?. Surg Endosc. 2022;36(1):352-360. doi:10.1007/s00464-021-08289-1\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bariatric surgery, Endoscopic sleeve gastroplasty (ESG), Robotic sleeve gastrectomy (RSG), EWL","lastPublishedDoi":"10.21203/rs.3.rs-5040568/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5040568/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWithin bariatric surgery, endoscopic sleeve gastroplasty (ESG) and robotic sleeve gastrectomy (RSG) have emerged as minimally invasive procedures for weight loss and metabolic management. While both offer benefits for obesity, the comparative effects in terms of weight loss, efficacy, and safety remain uncertain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA systematic search of PubMed/MEDLINE, and Cochrane Library was conducted to collect both prospective and retrospective studies assessing the effectiveness and safety of RSG and ESG in treating morbid obesity. Regression analysis was performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe collected eleven studies (1182 patients) evaluating RSG and fourteen studies (3077 patients) evaluating ESG. Average patient ages for RSG were 42.79±11.31 years (63.9% females) with preoperative Body Mass Index of 47.81+8.00 and 38.52±9.69 years (86.1% females) with BMI of 35.20±4.29 for ESG. Mean operation time was 104.93 minutes for RSG, and 68.4 for ESG. RSG yielded a Estimated Weight Loss % (%EWL) of 51.26% at 18 months, while ESG yielded 73.01%. Complication rates were 2.71% (32/1182) for RSG and 8.88% (273/3077) for ESG, while reoperation rates were 0.59% for RSG and 1.34% for ESG. Average hospital stays were 2.71 days for RSG and 0.68 days for ESG.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe long-term clinical results of RSG and ESG for morbid obesity show similarly favorable outcomes. ESG has shorter operative times and hospital stays, but more complications. Additional research with larger cohorts and randomized trials is needed to determine the preferred procedure.\u003c/p\u003e","manuscriptTitle":"Comparing Minimally Invasive Bariatric Techniques: A Systematic Review of Robotic Sleeve Gastrectomy vs. Endoscopic Sleeve Gastroplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-23 05:57:27","doi":"10.21203/rs.3.rs-5040568/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8828bb4a-61ff-4dcd-ae74-b1e228615722","owner":[],"postedDate":"October 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-23T05:57:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-23 05:57:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5040568","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5040568","identity":"rs-5040568","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}