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Several studies have recently conducted to investigate the link between anemia and bariatric surgery (BS). The results from these studies, however, were inconsistent. Therefore, a meta-analysis was conducted to determine whether BS for weight loss is a risk factor for anemia. Studies were identified relevant papers published a cutoff date of May 2022 for meta-analysis by searching four electronic databases (PubMed, EMBASE, Web of Science and Cochrane Library). Pairs of authors conducted title and abstract, full-text assessment, data extraction and risk of bias assessment, and quality of articles. Random-effects models were used to estimate the pooled effect size and evaluated the overall quality of evidence. The sources of heterogeneity were assessed with I 2 . The Newcastle-Ottawa scale (NOS) was used to assess the methodologic quality of selected studies. The publication bias was assessed using funnel plots and Egger's test statistics. In all, eight studies comprising 3150 patients were finally included in the final study analysis. Of these, pooled analysis of eight studies detecting association between anemia and BS for weight loss yield a statistically significant correlation (SMD −1.12 (−1.46—−0.78, I 2 = 93%). Subgroup analyses were performed according to postoperative follow-up time and operation method. Before 24 months postoperatively, no patient had a significant decrease in hemoglobin. More than 24 months after BS, patients show a significant reduction in hemoglobin. In addition, the hemoglobin level was not changed after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) (SMD −0.19 (−1.04—0.67, I 2 = 0% for SG; SMD −0.30 (−0.82—0.22 for AGB), but the hemoglobin level was significantly reduced after Roux-en-Y gastric bypass (RYGB) (SMD −1.19 (−1.52—−0.87, I 2 = 94.2%). This current meta-analysis found that at 24 months after RYGB, the patient's hemoglobin level was significantly reduced, increasing the risk of anemia. Therefore, attention should be paid to the occurrence of anemia after BS. A large, placebo-controlled, multi-center study is needed to clarify the role of BS for weight loss in this patient anemia. [ABSTRACT FROM AUTHOR]

Résumé La chirurgie bariatrique est reconnue comme une modalité à part entière du traitement de l’obésité sévère mais aussi de ses comorbidités. De nombreux centres de chirurgie bariatrique encouragent, voire imposent à leurs patients, une perte de poids durant la période pré-opératoire. Le but de cet article est de faire le point sur cette question et de proposer une attitude pratique dans l’attente de données concluantes. L’analyse de la littérature actuelle ne permet pas de conclure de façon univoque concernant l’intérêt de la perte de poids pré-opératoire dans le cadre de la chirurgie bariatrique. Il n’y a donc actuellement pas d’argument suffisant pour considérer que la perte de poids est un prérequis systématique à la chirurgie bariatrique. Le seul bénéfice démontré est la réduction de la taille du foie. Il reste cependant à démontrer par des études prospectives randomisées que la réduction du volume hépatique engendrée par la perte de poids pré-opératoire est accompagnée d’une réduction des complications per- et postopératoires sans risque de dénutrition. Bariatric surgery is recognized as a modality in its own right for the treatment of severe obesity but also of its comorbidities. Many centers of bariatric surgery encourage or even impose on their patients a weight loss before surgery. The purpose of this paper is to review the rationale of this practice and to propose a practical attitude in the expectation of conclusive data. The analysis of the current literature does not make it possible to conclude unequivocally about the value of preoperative weight loss in the context of bariatric surgery. There is thus currently no sufficient argument to consider that weight loss is a systematic prerequisite for bariatric surgery. The only benefit demonstrated is the reduction in liver size. It remains however to be demonstrated by randomized prospective studies that the reduction in hepatic volume caused by preoperative weight loss is accompanied by a reduction in per- and postoperative complications without any risk of undernutrition. [ABSTRACT FROM AUTHOR]