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Robotic Roux-en-Y gastric bypass (RRYGB) is an innovative alternative to traditional laparoscopic approaches. Literature has been published investigating its safety/efficacy; however, the quality of reporting is uncertain. This systematic review used the Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework to assess the reporting quality of available literature. A narrative summary was formulated, assessing how comprehensively governance/ethics, patient selection, demographics, surgeon expertise/training, technique description and outcomes were reported. Forty-seven studies published between 2005 and 2024 were included. There was incomplete/inconsistent reporting of governance/ethics, patient selection, surgeon expertise/training and technique description, with heterogenous outcome reporting. RRYGB reporting was poor and did not align with IDEAL guidance. Robust prospective studies reporting findings using IDEAL/other guidance are required to facilitate safe widespread adoption of RRYGB and other surgical innovations. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric surgery procedure in China. However, its cost-effectiveness in Chinese patients is currently unknown. Objectives: This study aims to assess the cost-effectiveness of LSG vs no surgery in Chinese patients with severe and complex obesity, taking into account both healthcare expenses and the potential improvement in health-related quality of life (HRQoL). Methods: A retrospective cohort study was conducted, encompassing 135 Chinese patients who underwent LSG between January 3, 2022 and December 29, 2022, at a major bariatric center. The study evaluated the cost-effectiveness from a healthcare service perspective, employing the incremental cost-effectiveness ratio (ICER) for quality-adjusted life years (QALYs) gained. The analyses compared LSG with the alternative of not undergoing surgery over a 1-year period, using actual data, and extended to a lifetime horizon by projecting costs and utilities at an annual discount rate of 3.0%. Subgroup analyses were undertaken to explore cost-effectiveness variations across different sex, age and BMI categories, and diabetes status, employing a one-way analysis of variance (ANOVA). To ensure the reliability of the findings, one-way and probabilistic sensitivity analyses were executed. Results: The results indicated that 1-year post-LSG, patients achieved an average total weight loss (TWL) of (32.7 ± 7.3)% and an excess weight loss (EWL) of (97.8 ± 23.1)%. The ICER for LSG compared to no surgery over a lifetime was $4,327/QALY, significantly below the willingness-to-pay (WTP) threshold for Chinese patients with severe and complex obesity. From a lifetime perspective, LSG proved to be cost-effective for all sex and age groups, across all BMI categories, and for both patients with and without diabetes. Notably, it was more cost-effective for younger patients, patients with higher BMI, and patients with diabetes. Conclusions: LSG is a highly cost-effective intervention for managing obesity in Chinese patients, delivering substantial benefits in terms of HRQoL improvement at a low cost. Its cost-effectiveness is particularly pronounced among younger individuals, those with higher BMI, and patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: There is little information about the effect of single nucleotide polymorphisms (SNP) and nutritional status and weight loss after bariatric surgery. This study investigated the interactive effect of eight obesity-related SNPs and nutritional status on weight loss after Roux-en-Y gastric bypass (RYGB). Method: This is a case–control study. After 1-year follow-up, the patients who underwent RYGB were dividing into two groups. The case group consisted of patients who lost more than 50% of their excess body weight (EBW%) 1 year after the surgery. The control group included patients who lost < 50% of EBW at same time frame. Then, the relationship between eight SNPs related to UCP2, FTO, LEPR, GHRL, and NPY genes with weight loss were checked. Results: In this study, 160 patients were recruited. The median of age for case and control group were 43 and 42 respectively. The presence of mutant variant NPYrs16147 had a significant relationship in terms of weight loss between the two groups (P > 0.05). In dominant model, two SNPs, UCP2 rs659366 and UCP2 rs660339, showed protective effect of the vitamin D deficiency. Conclusion: In conclusion, the presence mutant variant of NPYrs16147 is directly related to the incidence of weight loss greater than 50% of EBW. However, it is apparent individual behavioral, dietary, and other factors may have more influence on weight loss among patients underwent RYGB. [ABSTRACT FROM AUTHOR]

Several studies have indicated that miRNAs play crucial roles in adipogenesis, insulin resistance, and inflammatory pathways associated with obesity and change after metabolic bariatric surgery (MBS). This systematic review explores and maps the existing literature on how miRNAs are expressed and investigates the unique miRNAs with the effects after MBS. The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and EMBASE were searched from 2019 until February 2024. This SR found 825 miRNAs from 25 studies, identifying 507 unique ones not used twice in the same study. A total of 21 studies (84%) measured RNA before and after surgery. The miRNA used per study ranged from 1 to 146 miRNA types, with a median study sample size of just 27 patients per study, raising concerns about some conclusions' robustness. From the 507 unique miRNAs, only 16 were consistently analyzed in 4 to 7 studies, which gave 77 different outcomes in relation to miRNA after MBS. MiRNA 122 and 122-5p were analyzed the most. Others were 106b-5p, 140-5p, 183-5p, 199b-5p, 20b-5p, 424-5p, 486-5p, 7-5p, 92a, 93-5p, 194-5p, 21-5p, 221, 320a, and 223-3p. A gap was observed in many studies, whereby the results were not the same, or there was no explanation for the effects after MBS was given within the same miRNA. Fifteen miRNAs were reported to have the same upward and downward trend, although not within the same study, and only 26.1% employed some form of statistical modeling to account for bias or confounding factors. Directions and effects in miRNA are visible, but still, inconsistent outcomes linked to the same miRNA after MBS, underscoring the need for clarity in miRNA-outcome relationships. Collaborative efforts, consensus-driven miRNA dictionaries, and larger, more rigorous studies are necessary to improve methodology designs and improve outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is a safe and effective healthcare pathway. However, there is limited understanding of the patient perspective on SDD. The aim of this study was to explore patient satisfaction and experience with SDD after RYGB. Methods: A mixed-methods study with a concurrent design was conducted in a Dutch teaching hospital, using questionnaires and interviews. Patients who underwent RYGB and were discharged on the day of the surgery completed four questionnaires of the BODY-Q (satisfaction with the surgeon, satisfaction with the medical team, satisfaction with the office staff, and satisfaction with information provision) ± 4 months postoperative. The results of the questionnaires were compared with pre-existing data from a cohort of patients who stayed overnight after surgery (i.e., control group). A subset of patients was individually interviewed for an in-depth understanding of the patient perspective on SDD. Results: In the questionnaires, median scores for the control group (n = 158) versus the present group of patients (n = 51) were as follows: 92/100 vs. 92/100 (p = 0.331) for the surgeon, 100/100 vs. 92/100 (p = 0.775) for the medical team, 100/100 vs. 100/100 (p = 0.616) for the office staff, and 90/100 vs. 73/100 (p = 0.015) for information provision. Interviews with 14 patients revealed seven themes, describing high satisfaction, along with several points of interest. Conclusions: Patient satisfaction with SDD after RYGB is high, although information provision regarding the day of surgery could be improved. However, not every medically eligible patient might be suitable for this healthcare pathway, as responsibilities are shifted. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery improves many obesity-related comorbidities, yet the literature remains inconclusive on the impact of bariatric surgery on asthma. Our primary objective was to identify the long-term impact of bariatric surgery on asthma severity and medication use. Methods: A retrospective review was completed of all patients with a diagnosis of asthma who underwent bariatric surgery over 10 years at a single institution. Primary outcomes were the number of asthma medications prescribed at five time points (preoperative, postoperative < 18 months, 19–36 months, 37–60 months, 60 + months) after bariatric surgery. Secondary outcomes were spirometry results and BMI. Results: There were 260 patients with 84.6% female predominance. There were 168 sleeve gastrectomy patients and 92 Roux-en-Y gastric bypass patients. Mean age was 47.6 ± 10.7 years, mean BMI was 46.0 ± 6.8 kg/m2, and 54.2% were previous tobacco users. The total number of patients on two or more asthma medications decreased from 46% preoperatively to 41% at 18 months, to 36% at 36 months, and to 32% at 60 months after surgery. The total number of patients free from asthma medication increased from 25% preoperatively to 33% at 60 months postoperatively. Asthma medication use decreased in both surgery groups, and neither operation demonstrated superiority. No significant improvement nor differences were found between groups at any time point regarding FEV1/FVC ratio spirometry measures. Conclusion: Bariatric surgery reduces the use of medications taken for management of asthma. The amount of asthma medication usage decreases with time and is sustained at 60 months after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: The prevalence of GERD is increasing among individuals with obesity, and RYGB is an effective procedure to control GERD and obesity. However, some patients continue to have GERD after RYGB. The aim of this study was to investigate the prevalence and the risk factors for GERD after RYGB. Material and Methods: This prospective study included 180 RYGB patients followed for an average of 12.2 (0.6) years. In total, 126 (70%) patients agreed to participate and provided data on their weight, GERD symptoms, and filled the GERD-HRQL, TFEQ-18, and GSRS questionnaires. Results: The average age before surgery was 42.7 (10.5) years, and BMI was 45.2 (6.4) kg/m2. Moreover, 128 (71.1%) were females, and preoperative GERD was diagnosed in 74 (41.1%) patients. At the 12-year follow-up, the mean %EBMIL and %TWL was 60.37 and 25.73, respectively. The median %WR was 18.0 (39.0). Postoperative GERD was present in 30 (23.8%) patients, of whom 12 (40%) continued to have GERD symptoms and 18 (60%) developed de novo GERD. The GERD-HRQL score significantly decreased from 3.0 (9.0) at baseline to 2.0 (5.0) (p = 0.028) at 12 years. GSRS Diarrhea and Indigestion scores increased significantly from 1.33 (0.67) to 1.5 (2.42) (p < 0.001) and from 2.0 (1.25) to 2.25 (1.25) (p < 0.001), respectively. No change in the cognitive restraint score was observed. Uncontrolled eating and emotional eating scores decreased from 51.85 (22.22) to 40.74 (33.33) (p < 0.001) and from 44.44 (44.44) to 33.33 (22.22) (p < 0.001), respectively. In the multivariate analysis, %WR > 11 (OR = 3.22, p = 0.029) and GSRS Diarrhea score (OR = 3.21, p = 0.027) were significant predictors of GERD 12 years after RYGB. Conclusions: RYGB was an effective procedure to control GERD; however, 23.8% had persistent or de novo GERD after 12 years. The independent risk factors associated with GERD after RYGB were weight regain and GSRS Diarrhea score. [ABSTRACT FROM AUTHOR]

Background and Objectives: Cancer is a multicausal disease, and environmental, cultural, socioeconomic, lifestyle, and genetic factors can influence the risk of developing cancer. Colorectal cancer (CRC) stands as the third most common cancer globally. Some countries have observed a rise in the incidence of CRC, especially among young people. This increase is associated with lifestyle changes over the last few decades, including changes in diet patterns, a sedentary lifestyle, and obesity. Currently, obesity and overweight account for approximately 39% of the world's population and increase the risk of overall mortality of certain cancer types. This study aims to conduct a literature review examining the association between obesity and CRC. Materials and Methods: This narrative review explored the pathophysiological mechanisms, treatment strategies, and challenges related to obesity and CRC. Results: Several studies have established a clear causal relationship between obesity and CRC, showing that individuals with morbid obesity are at a higher risk of developing colorectal cancer. The adipose tissue, particularly the visceral, secretes proinflammatory cytokines, such as TNF-alpha, interleukin-6, and C-reactive protein. Chronic inflammation is closely linked to cancer initiation and progression, with a complex interplay of molecular mechanisms underlying this association. Obesity can complicate the treatment of CRC due to several factors, reducing the therapeutic effectiveness and increasing the risk for adverse events during treatment. Dietary modification, calorie restriction, and other types of weight-control strategies can reduce the risk of CRC development and improve treatment outcomes. Conclusions: Obesity is intricately linked to CRC development and progression, making it a crucial target for intervention, whether through diet therapy, physical exercises, medical therapy, or bariatric surgery. [ABSTRACT FROM AUTHOR]

Bariatric surgery is widely recognized as the most effective intervention for obesity and offers benefits beyond weight loss. However, not all patients achieve satisfactory weight loss, balanced changes in body composition, and resolution of comorbidities. Therefore, thorough pre- and postoperative evaluations are important to predict success and minimize adverse effects. More comprehensive assessments require broadening the focus beyond body weight and fat measurements to consider quantitative and qualitative evaluations of muscles. Introducing the concept of sarcopenia is useful for assessing the degradative and pathological changes in muscles associated with cardiometabolic function, physical performance, and other obesity-related comorbidities in patients undergoing bariatric surgery. However, there is currently no consensus or definition regarding the research and clinical use of sarcopenia in patients undergoing bariatric surgery. Therefore, this review aimed to define the concept of sarcopenia applicable to patients undergoing bariatric surgery, based on the consensus reached for sarcopenia in the general population. We also discuss the methods and significance of measuring muscle mass, quality, and strength, which are key variables requiring a comprehensive assessment. [ABSTRACT FROM AUTHOR]

Glycine is deficient in individuals with obesity but improves following bariatric surgery. Glycine deficiency could impair glutathione (GSH) synthesis and worsen oxidative stress. We examined the impact of obesity-associated glycine deficiency and bariatric surgery on GSH synthesis. Twenty-one participants with severe obesity and twenty-one healthy weight controls were recruited. [1,2-13C2] glycine was infused to measure the erythrocyte (RBC) GSH synthesis rate. Participants with obesity underwent bariatric surgery, and 19 were restudied six months post-surgery. Compared to healthy weight controls, individuals with obesity had significantly lower concentrations of RBC GSH (2.43 ± 0.23 vs. 2.63 ± 0.26 mmol/L, p < 0.01). However, there were no differences in GSH fractional synthesis rate [78.0 (51.4–123.7) vs. 76.9 (49.3–110.1) % pool/day, p = 0.58] or absolute synthesis rate [1.85 (1.25–3.32) vs. 1.92 (1.43–3.03) mmol/L RBC/day, p = 0.97]. Despite a post-surgery increase in glycine concentration, no statistically significant changes in RBC GSH concentration or synthesis rates were detected. Further, the significant correlation between plasma glycine and RBC GSH concentration at baseline (r = 0.46, p < 0.01) was also lost following bariatric surgery. GSH concentration was significantly lower in participants with obesity, but bariatric surgery did not significantly increase GSH concentrations or synthesis rates. [ABSTRACT FROM AUTHOR]

Energy restriction (ER) is a nutrition method to reduce the amount of energy intake while maintaining adequate nutrition. In clinical medicine, applications of ER have been implicated in longevity, mortality, metabolic, immune, and psychological health. However, there are limited studies showing the clinical benefit of ER within the immediate surgical setting. A specific, clinically oriented summary of the potential applications of ER is needed to optimize surgery outcomes for patients. The purpose of this article is to examine how ER can be used for perioperative optimization to improve outcomes for the patient and surgeon. It will also explore how these outcomes can feasibly fit in with enhanced recovery after surgery protocols and can be used as a method for nutrition optimization in surgery. Despite evidence of caloric restriction improving outcomes in critically ill surgical patients, there is not enough evidence to conclude that ER, perioperatively across noncritically ill cohorts, improves postoperative morbidity and mortality in elective surgeries. Nevertheless, a contemporary account of how ER techniques may have a significant role in reducing risk factors of adverse surgical outcomes in this cohort, for example, by encouraging preoperative weight loss contributing to decreased operating times, is reviewed. [ABSTRACT FROM AUTHOR]

We aimed to assess the weight loss trend following Roux en Y Gastric Bypass (RYGB), One Anastomosis Gastric Bypass (OAGB), and Sleeve Gastrectomy (SG), utilizing a change-point analysis. A retrospective cohort study was conducted on 8640 patients, from 2009 to 2023. The follow-up period extended to 7 years, with a median follow-up of 3 years (interquartile range: 1.4–5). Following metabolic bariatric surgery, four weight loss phases (three change points) were observed. The primary, secondary, and tertiary phases, transitioned at 12.64–13.73 days, 4.2–4.8 months, and 11.3–13.1 months post-operation, respectively, varying based on the type of procedure. The weight loss rate decreased following each phase and plateaued after the tertiary phase. The nadir weight was achieved 11.3–13.1 months post-procedure. There was no significant difference in the %TWL between males and females, however, males achieved their nadir weight significantly earlier. Half of the maximum %TWL was achieved within the first 5 months, with the greatest reduction rate in the first 2 weeks. Our findings inform healthcare providers of the optimal timing for maximum weight loss following each surgical method and underscore the importance of close patient monitoring in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Obesity is known as a risk factor for cardiovascular disease (CVD). However, there is an absence of preoperative cardiac risk assessment in bariatric surgery candidates and the incidence of CVD among these high-risk patients is still unknown. Methods: A consecutive series of bariatric surgery candidates at two Chinese tertiary hospitals received coronary CT angiography or coronary angiography from 2017 to 2023. Patients were categorized as metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO) based on the presence or absence of MetS. CVD was diagnosed based on the maximum intraluminal stenosis > 1% in any of the segments of the major epicardial coronary arteries. Obstructive CVD was defined as coronary stenosis ≥ 50%. Binary multivariable logistic regression was performed to analyze the association between CVD and metabolic status. The number of principal MetS components was categorized into zero (without glycemic, lipid, and BP components), one (with one of the components), two (with any two components), and three (with all components) to explore their association with CVD. Results: A total of 1446 patients were included in the study. The incidence of CVD and obstructive CVD were 31.7% and 9.6%. Compared with MHO patients, MUO patients had a significantly higher incidence of mild (13.7% vs. 6.1%, P < 0.05), moderate (7.4% vs. 0.8%, P < 0.05), and severe CVD (3.1% vs. 0%, P < 0.05). Following complete adjustment, compared with zero or one component, two principal MetS components was found to be associated with a notable increase in the risk of CVD (OR 2.05, 95% CI 1.18–3.58, P < 0.05); three principal MetS components were observed to have a higher risk of CVD and obstructive CVD (OR 2.68, 95% CI 1.56–4.62, P < 0.001; OR 3.93, 95% CI 1.19–12.93, P < 0.05). Each increase in the number of principal MetS components correlated with a 1.47-fold (95% CI 1.20–1.81, P < 0.001) and 1.78-fold (95% CI 1.24–2.55, P < 0.05) higher risk of CVD and obstructive CVD, respectively. Conclusion: This study reported the incidence of CVD based on multicenter bariatric surgery cohorts. CVD is highly prevalent in patients with obesity, especially in MUO patients. Increased number of principal MetS components will significantly elevate the risk of CVD. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) are the two most commonly performed bariatric surgeries for the treatment of obesity. This meta-analysis was performed with the aim of summarizing the available evidence on weight loss, remission of comorbidities, and quality of life in LRYGB and LSG, complementing the current literature. Methods: We searched PubMed, EMBASE and the Cochrane Library from January 2012 to June 2023 for randomized controlled trials and non-randomized interventional studies. We finally selected 18 eligible studies. Results: LRYGB resulted in greater weight loss compared with LSG at 5 years [WMD= -7.65 kg/m², 95% confidence interval (CI) -11.54 to -3.76, P = 0.0001], but there exists high heterogeneity with I²=84%. Resolution rate of type 2 diabetes mellitus (T2D) (OR = 0.60, 95%Cl 0.41–0.87, p = 0.007) and dyslipidemia (OR = 0.44, 95%Cl 0.23–0.84, p = 0.01) was higher in the LRYGB group than that in the LSG group at 5 years. There was no difference between LRYGB and LSG for remission of hypertension, and obstructive sleep apnea. No differences were observed in the QoL after LRYGB or LSG. Morbidity was lower in the LSG group (WMD = -0.07, 95% CI: -0.13, -0.02, P = 0.01) than in the LRYGB group. No statistically significant difference was found in mortality between the two procedures. Conclusion: At 5 years after surgery, LRYGB resulted in greater weight loss and achieved better remission rate of T2D and dyslipidemia than LSG. However, LSG has a lower morbidity rate than that of LRYGB. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Despite the success of sleeve gastrectomy (SG) in of weight loss and treatment of the medical problems associated with obesity, some concerns have arisen about the need for revisional surgeries after SG in some patients. This study aimed to present an updated and comprehensive comparison among the presently available revisional surgeries employed explicitly in cases of inadequate outcomes after SG, which is the most frequently performed bariatric surgery in contemporary practice.This network meta‐analysis included studies that compared the outcomes of different revisional bariatric procedures after an inadequate outcome of SG.Searching across the electronic databases yielded 31 eligible articles. Re‐SG was associated with the highest rate of significant complications. Patients treated with single anastomosis duodenal‐ileal bypass (SADI) had a significantly higher percentage of total weight loss (%TWL) than those treated with one anastomosis gastric bypass (OAGB) and Roux‐en‐Y gastric bypass (RYGB). The percentage of excess weight loss (%EWL) at the end of the follow‐up period was significantly higher in patients in the SADI group compared to those in the RYGB group and the OAGB, and re‐SG exhibited the least values compared to SADI, biliopancreatic diversion with duodenal switch (BPD/DS), and OAGB. Significantly lower rates of reflux worsening/de novo development were observed in the SADI group compared to the OAGB group and the re‐SG group, which showed significantly higher rates than SADI and RYGB.Our comprehensive network meta‐analysis highlights SADI as a promising revisional option post‐SG, demonstrating superior weight loss outcomes, lower significant complication rates, and a favorable impact on reflux compared to other procedures. While acknowledging the limitations of our study, these findings support the potential efficacy of SADI in addressing the challenges of inadequate weight loss after sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop a machine learning model for predicting 30-day readmission after bariatric surgery based on laboratory tests. Data were collected from patients who underwent bariatric surgery between 2018 and 2023. Laboratory test indicators from the preoperative stage, one day postoperatively, and three days postoperatively were analyzed. Least absolute shrinkage and selection operator regression was used to select the most relevant features. Models constructed included support vector machine (SVM), generalized linear model, multi-layer perceptron, random forest, and extreme gradient boosting. Model performance was evaluated and compared using the area under the receiver operating characteristic curve (AUROC). A total of 1262 patients were included, of which 7.69% of cases were readmitted. The SVM model achieved the highest AUROC (0.784; 95% CI 0.696–0.872), outperforming other models. This suggests that machine learning models based on laboratory test data can effectively identify patients at high risk of readmission after bariatric surgery. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a silent pandemic affecting all ages and is a component of metabolic syndrome. Its treatment is conducted by lifestyle and behavioral changes, pharmacological therapy, and when correctly indicated, bariatric surgery. In recent years, the procedures for weight loss have been investigated due to their relationship with the development of many types of cancer. Although many studies have shown that bariatric surgery decreases cancer risk, other researchers observed an increase in this association. Carcinogenesis is affected by many factors, such as age, sex, type of cancer, and the bariatric surgery performed on each patient. This systematic review and meta-analysis protocol aims to clarify the association between the different modalities of bariatric surgery and the risk of cancer development in adult patients with metabolic syndrome. Method and analysis: The proposed systematic review and meta-analysis will be reported conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines. This research will include observational studies (case-control and cohort studies) about patients who undergo bariatric surgery due to metabolic syndrome. Will be accepted in any language and any year. Publications without peer review will be excluded from this review. Data will be entered into the Review Manager software (RevMan5.2.3). We extracted or calculated the OR and 95% CI for dichotomous outcomes for each study. In case of heterogeneity (I2>50%), the random-effects model will combine the studies to calculate the OR and 95% CI. Ethics and dissemination: This study will review the published data; Thus, obtaining ethical approval is unnecessary. The findings of this systematic review will be published in a peer-reviewed journal. Prospero registration number: CRD42023432079. [ABSTRACT FROM AUTHOR]

Summary The quality of general obesity management before bariatric surgery (BS) is rarely investigated. Inadequate information regarding undetected and undiagnosed comorbidities (UUCs) in individuals with obesity may influence the penetration, risks, and outcomes of BS. We conducted a cohort study involving a pre‐specified medical check‐up in a cooperation between a BS department and an outpatient medical centre. A total of 1068 patients (74.4% women) were enrolled in the study. The mean age was 42.1 years (standard deviation [SD] 11.9) and the mean body mass index (BMI) was 46.1 (SD 6.91). The onset of obesity occurred in 11.4% of patients during childhood, 47.2% during schooltime/adolescence, 41.4% in adulthood. Gender differences were observed: men had higher BMI, systolic blood pressure, and impaired metabolic state (including diabetes, dyslipidemia, and liver disease with p‐values <.001 for all). Women had lower haemoglobin levels, impaired iron status, lower albumin levels (p < .001), and increased C‐reactive protein levels (p < .05). The prevalence of UUC conditions (percentage of cases) was as follows: arterial hypertension, 53%; decreased cystatin C clearance, 57%; dyslipidemia, 41%; fatty liver, 40%; iron deficiency, 37%; diabetes mellitus, 34%; vitamin D deficiency, 32%; chronic pain syndrome, 23%; liver fibrosis, 12%; obstructive sleep apnea, 10%; and vitamin deficiencies (vitamin B12, folic acid, vitamin K1) <10%. Undiagnosed hypertension was more prevalent in younger women, and nutritional deficits were associated with high BMI in both genders. Older age and high BMI were associated with undiagnosed diabetes and decreased glomerular filtration rate in both genders, and with liver fibrosis in men. UUC are highly prevalent in individuals undergoing BS. A refined assessment is recommended to improve health conditions and outcome in these candidates. [ABSTRACT FROM AUTHOR]

Summary Background Methods Results Conclusions The purpose of this study was to assess the impact of metabolic and bariatric surgery (MBS) on Quality of Life (QoL) in Indian patients with obesity over 10 years.A retrospective chart review was conducted at 11 centres for individuals with MBS between February 2013 and May 2022. Patient medical records provided the source of de‐identified data.Data from 2132 individuals with a mean age of 43.28 ± 11.96 years was analysed. There were 37.43% men and 62.57% females in the study population. The study population had a mean preoperative body mass index (BMI) of 45.71 ± 10.38 kg/m2. The Bariatric Analysis and Reporting Outcome System (BAROS) scoring method showed a higher overall QoL score throughout all follow‐up periods, with ‘very good’ outcomes at one, three and 7 years and ‘good’ outcomes at 5 and 10 years. Improvements in QoL were associated with a substantial improvement (p < .01) in BMI at every follow‐up time point.Following MBS, individuals with obesity exhibited a substantial and long‐term improvement in their overall QoL for up to 10 years. This study presents Indian data on QoL, which is considered one of the most important decision‐making factors for or against an intervention. [ABSTRACT FROM AUTHOR]

Background: Obesity is closely associated with upper gastrointestinal disorders. The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) before bariatric surgery remains a topic of debate. This study aimed to describe the pathological endoscopic findings in individuals qualified for bariatric surgery. Methods: Retrospective analysis was conducted on preoperative gastroscopy reports of patients who underwent bariatric surgery at our hospital between October 2022 and October 2023. Results: A total of 405 patients were included in the study. The two most prevalent endoscopic findings during EGD in this patient cohort were chronic superficial gastritis (326/405, 80.5%) and reflux esophagitis (82/405, 20.2%). Some patients exhibited two or more abnormalities. Patients with reflux esophagitis were older, had a higher proportion of men, higher BMI, higher rates of smoking and drinking compared to those without it (P = 0.033, P < 0.001, P = 0.003, P = 0.001, and P = 0.003, respectively). Morbid obesity (P = 0.037), smoking habits (P = 0.012), and H. pylori infection (P = 0.023) were significant risk factors for reflux esophagitis in male patients, while age (P = 0.007) was the sole risk factor in female patients. No statistically significant differences were observed in surgical procedures between LA-A and B groups (P = 0.382), but statistically significant differences were noted between the nondiabetic and diabetic groups (P < 0.001). Conclusions: Preoperative EGD can unveil a broad spectrum of pathologies in patients with obesity, suggesting the need for routine examination before bariatric surgery. The findings of this study can guide bariatric surgeons in developing tailored treatments and procedures, thus significantly enhancing prognosis. Gastroscopy should be performed routinely in Chinese patients planning to undergo bariatric surgery. [ABSTRACT FROM AUTHOR]

Purpose: Depression is prevalent in patients undergoing bariatric surgery (BSx). Long-term use of antidepressant is associated with weight gain, particularly the use of selective serotonin reuptake inhibitors (SSRIs). Little is known about whether different types of antidepressants affect the response to BSx. The purpose of this study was to determine the relationship between SSRI use and nutritional and biochemical measurements in those with obesity pre-/post-BSx. Methods: This is a cross-sectional and prospective cohort study. Patients were enrolled pre-BSx and divided into 3 groups: SSRI, non-SSRI and no antidepressant. Nutritional, biochemical and pharmacological data were collected pre- and 6 months post-BSx. Results: Pre-BSx, 77 patients were enrolled: 89.6% female, median age 45 years and body mass index (BMI) of 45.3 kg/m2. 14.3% were taking SSRIs and had a significantly higher BMI (52.1 kg/m2) compared to 62.3% in no antidepressant (46.0 kg/m2) and 23.4% in non-SSRI antidepressants (43.1 kg/m2). At 6 months post-BSx (n = 58), the SSRI group still had significantly higher BMI in comparison to the other two groups. No other significant differences found between groups. Conclusion: Despite higher BMI, patients taking SSRI and undergoing BSx had similar responses, based on nutritional and biochemical parameters, to those on non-SSRI or no antidepressants. Level of evidence: Level III: Evidence obtained from well-designed cohort or case–control analytic studies. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery can lead to short-mid-term vitamin deficiencies, but the long-term vitamin deficiencies is unclear. This study aimed to conduct a meta-analysis regarding the long-term prevalence (≥ 5 years) of vitamin deficiencies after bariatric surgery. Methods: We searched the EMBASE, PubMed, and CENTRAL databases for clinical studies until June 2023. Meta-analysis, sensitivity, subgroup, and meta-regression analyses were performed. Results: This meta-analysis included 54 articles with follow-up duration ranging from 5 to 17 years. The most prevalent vitamin deficiencies after surgery were vitamin D (35.8%), followed by vitamin E (16.5%), vitamin A (13.4%), vitamin K (9.6%), and vitamin B12 (8.5%). Subgroup analyses showed that the prevalence of vitamin A and folate deficiencies increased with the follow-up time. Roux-en-Y gastric bypass had a higher rate of vitamin B12 deficiency than sleeve gastrectomy and biliopancreatic diversion with duodenal switch (BPD-DS). Studies conducted in Europe had higher vitamin A deficiency (25.8%) than in America (0.8%); Asian studies had more vitamin B12 but less vitamin D deficiency than European and American studies. Meta-regression analysis displayed that publication year, study design, preoperative age, BMI, and quality assessment score were not associated with vitamin A, B12, D, and folate deficiencies rate. Conclusion: A high prevalence of vitamin deficiencies was found after bariatric surgery in the long-term follow-up, especially vitamin D, E, A, K, and B12. The variation in study regions, surgical procedures, and follow-up time are associated with different postoperative vitamin deficiencies; it is necessary to develop more targeted vitamin supplement programs. [ABSTRACT FROM AUTHOR]

Introduction: The Single Anastomosis Sleeve Ileal (SASI) bypass is a new bariatric surgery corresponding to an adaptation of the Santoro approach, consisting of a sleeve gastrectomy (SG) followed by loop gastroileostomy. Therefore, we aimed to systematically assess all the current literature on SASI bypass in terms of safety, weight loss, improvement in associated comorbidities, and complications. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) recommendations, we conducted a systematic review and meta-analysis by searching three databases (PubMed, Scopus, and Web of Science). We performed a meta-analysis of risk ratios and mean differences to compare surgical approaches for excessive weight loss, improvement/remission in type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), obstructive sleep apnea (OSA), and complications. Heterogeneity was assessed using the I2 statistic. Results: Eighteen studies were included in the qualitative analysis and four in the quantitative analysis, comparing SASI bypass with SG and One-Anastomosis Gastric Bypass (OAGB). A comparison between Roux-en-Y Gastric Bypass (RYGB) and SASI bypass could not be performed. Compared to SG, the SASI bypass was associated with improved weight loss (MD = 11.32; 95% confidence interval (95%CI) [7.89;14.76]; p < 0.0001), and improvement or remission in T2DM (RR = 1.35; 95%CI [1.07;1.69]; p = 0.011), DL (RR = 1.41; 95%CI [1.00;1.99]; p = 0.048) and OSA (RR = 1.50; 95%CI [1.01;2.22]; p = 0.042). No statistically significant differences in any of the assessed outcomes were observed when compared with OAGB. When compared to both SG and OAGB, the complication rate of SASI was similar. Conclusion: Although studies with longer follow-up periods are needed, this systematic review and meta-analysis showed that SASI bypass has a significant effect on weight loss and metabolic variables. Variations in outcomes between studies reinforce the need for standardization. [ABSTRACT FROM AUTHOR]

(1) Background: Obesity poses known risks in surgery, including a prolonged operation time and postoperative complications. Given the rising obesity rates and frequent lumbar disc surgeries, understanding these risks is crucial. This study aims to assess the impact of obesity on operation duration and postoperative complications in lumbar disc prolapse surgery. (2) Methods: We retrospectively analyzed 598 patients with monosegmental disc herniation, correlating their body mass index (BMI) as a surrogate parameter for obesity with operation time. Excluding complex cases (multi-segmental herniations or recurrent herniations), complication rates and hospital stays were recorded. Simulated surgeries on 3D-printed models of varying obesity levels examined operation times and instrument suitability. (3) Results: Of these patients, 438 patients had a BMI of <30, and 160 patients had a BMI of ≥30. Complication rates showed no significant differences between groups. Linear regression analysis failed to establish a sole dependency of operation time on BMI, with R2 = 0.039 for the normal-weight group (BMI < 30) and R2 = 0.059 for the obese group (BMI ≥ 30). The simulation operations on the 3D-printed models of varying degrees of obesity showed a significant increase in the simulated operation time with higher levels of obesity. A geometrically inadequate set of surgical instruments was assumed to be a significant factor in the simulated increase in operating time. (4) Conclusions: While various factors influence operation time, obesity alone does not significantly increase it. However, simulated surgeries highlighted the impact of obesity, particularly on instrument limitations. Understanding these complexities is vital for optimizing surgical outcomes in obese patients. [ABSTRACT FROM AUTHOR]

Background: The adoption of robotic bariatric surgery has increased dramatically over the last decade. While outcomes comparing bariatric and laparoscopic approaches are debated, little is known about patient factors responsible for the growing delivery of robotic surgery. A better understanding of these factors will help guide the planning of bariatric delivery and resource allocation. Methods: Data were extracted from the MBSAQIP registry from 2020 to 2021. The patient population was organized into primary robot-assisted sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) versus those who underwent laparoscopic procedures. Bivariate analysis and multivariable logistic regression modeling were conducted to characterize cohort differences and identify independent patient predictors of robotic selection. Results: Of 318,151, 65,951 (20.7%) underwent robot-assisted surgery. Patients undergoing robotic procedures were older (43.4 ± 11.8 vs. 43.1 ± 11.8; p < 0.001) and had higher body mass index (BMI; 45.4 ± 7.9 vs. 45.0 ± 7.6; p < 0.001). Robotic cases had higher rates of medical comorbidities, including sleep apnea, hyperlipidemia, gastroesophageal reflux disease (GERD), and diabetes mellitus. Robotic cases were more likely to undergo RYGB (27.4% vs. 26.4%; p < 0.001). Robotic patients had higher rates of numerous complications, including bleed, reoperation, and reintervention, resulting in higher serious complication rates on multivariate analysis. Independent predictors of robotic selection included increased BMI (aOR 1.02), female sex (aOR 1.04), GERD (aOR 1.12), metabolic dysfunction, RYGB (aOR 1.08), black racial status (aOR 1.11), and lower albumin (aOR 0.84). Conclusions: After adjusting for comorbidities, patients with greater metabolic comorbidities, black racial status, and those undergoing RYGB were more likely to receive robotic surgery. A more comprehensive understanding of patient factors fueling the adoption of robotic delivery, as well as those expected to benefit most, is needed to better guide healthcare resources as the landscape of bariatric surgery continues to evolve. [ABSTRACT FROM AUTHOR]

Obesity is frequently accompanied by non-alcoholic fatty liver disease (NAFLD). These two diseases are associated with altered lipid metabolism, in which reverse cholesterol transport (LXRα/ABCA1/ABCG1) and leptin response (leptin receptor (Ob-Rb)/Sam68) are involved. The two pathways were evaluated in peripheral blood mononuclear cells (PBMCs) from 86 patients with morbid obesity (MO) before and six months after Roux-en-Y gastric bypass (RYGB) and 38 non-obese subjects. In the LXRα pathway, LXRα, ABCA1, and ABCG1 mRNA expressions were decreased in MO compared to non-obese subjects (p < 0.001, respectively). Ob-Rb was decreased (p < 0.001), whereas Sam68 was increased (p < 0.001) in MO. RYGB did not change mRNA gene expressions. In the MO group, the LXRα pathway (LXRα/ABCA1/ABCG1) negatively correlated with obesity-related variables (weight, body mass index, and hip), inflammation (C-reactive protein), and liver function (alanine-aminotransferase, alkaline phosphatase, and fatty liver index), and positively with serum albumin. In the Ob-R pathway, Ob-Rb and Sam68 negatively correlated with alanine-aminotransferase and positively with albumin. The alteration of LXRα and Ob-R pathways may play an important role in NAFLD development in MO. It is possible that MO patients may require more than 6 months following RYBGB to normalize gene expression related to reverse cholesterol transport or leptin responsiveness. [ABSTRACT FROM AUTHOR]

(1) Background: Bariatric surgery has demonstrated the capacity to improve metabolic-associated fatty liver disease (MAFLD) in patients with morbid obesity. In addition, the Mediterranean diet contains anti-inflammatory, anti-oxidative, and anti-fibrotic components, promoting a beneficial effect on MAFLD. This study aimed to assess the improvement of MAFLD, specifically liver steatosis, in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGB) and following a hypocaloric Mediterranean-like diet. (2) Methods: A prospective observational pilot study of 20 patients undergoing RYGB was conducted. The participants underwent a magnetic resonance spectroscopy study 2 weeks before the surgical act and one year postoperatively to assess the percentage of lipid content (PLC). The adherence to the Mediterranean diet was determined by the KIDMED test 1 year after surgery. (3) Results: Mean baseline PLC was 14.2 ± 9.4%, and one year after surgery, it decreased to 4.0 ± 1.8% (p < 0.001). A total of 12 patients (60%) were within the range of moderate adherence to the Mediterranean diet, whereas 8 patients (40%) showed a high adherence. The patients with high adherence to the Mediterranean diet presented significantly lower values of postoperative PLC. (4) Conclusions: Liver steatosis significantly reduces after RYGB. This reduction is further improved when associated with a high adherence to a Mediterranean diet. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin B1 (thiamine) deficiency (TD) after metabolic and bariatric surgery (MBS) is often insidious and, if unrecognized, can lead to irreversible damage or death. As TD symptoms are vague and overlap with other disorders, we aim to identify predictors of recurrent TD and failure to collect B1 labs. Methods: We analyzed a large sample of data from patients with MBS (n = 878) to identify potential predictors of TD risk. We modeled recurrent TD and failure to collect B1 labs using classical statistical and machine learning (ML) techniques. Results: We identified clusters of labs associated with increased risk of recurrent TD: micronutrient deficiencies, abnormal blood indices, malnutrition, and fluctuating electrolyte levels (aIRR range: 1.62–4.68). Additionally, demographic variables associated with lower socioeconomic status were predictive of recurrent TD. ML models predicting characteristics associated with failure to collect B1 labs achieved 75–81% accuracy, indicating that clinicians may fail to match symptoms with the underlying condition. Conclusions: Our analysis suggests that both clinical and social factors can increase the risk of life-threatening TD episodes in some MBS patients. Identifying these indicators can help with diagnosis and treatment. [ABSTRACT FROM AUTHOR]

We aimed to examine the association between weight loss, dietary patterns, diabetes, and glycemic control among Qatari adults with a history of bariatric surgery (BS). Data from 1893 adults from the Qatar Biobank study were analyzed. Diabetes was defined by blood glucose, HbA1c, and medical history, with poor glycemic control defined as HbA1c ≥ 7.0%. The dietary patterns were derived from a Food Frequency Questionnaire using factor analysis. The participants' mean age was 38.8 years, with a mean weight loss of 23.4% and a 6.1% prevalence of poor glycemic control. Weight loss was inversely associated with diabetes and poor glycemic control. The traditional dietary pattern (high intake of Biryani, chicken, meat, fish dishes, zaatar fatayer, croissant, lasagna, and Arabic bread) was inversely associated with diabetes prevalence, with an OR of 0.61 (95%CI, 0.41–0.99) when comparing extreme quartiles. No significant associations were found between prudent or sweet dietary patterns and diabetes. Among the individuals with known diabetes, the prevalence of remission was 33.4%, with an OR for remission of 5.94 (95%CI, 1.89–18.69) for the extreme quartiles of weight loss. In conclusion, weight loss and traditional dietary patterns are inversely associated with diabetes and glycemic control among adults with a history of BS, with weight loss being the main determinant. [ABSTRACT FROM AUTHOR]

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The aim of this case series report is to provide a new topical view of styletubation (video intubating stylet technique) in obese patients undergoing bariatric surgeries. In contrast to various conventional direct laryngoscopes (DLs), videolaryngoscopes (VLs) have been applied in such obese populations with potentially difficult airway complications. The safety and effectiveness of VLs have been repeatedly studied, and the superiority of VLs has then been observed in and advocated for routine use. In this article, among our vast use experiences with styletubation (more than 54,998 patients since 2016) for first-line routine tracheal intubation, we present the unique experience to apply the styletubation technique in obese patients undergoing bariatric surgery. Consistent with the experiences applied in other patient populations, we found the styletubation technique itself to be swift (the time to intubate from 5 s to 24 s), smooth (first-attempt success rate: 100%), safe (no airway complications), and easy (high subjective satisfaction). The learning curve is steep, but competency can be enhanced if technical pitfalls can be avoided. We, therefore, propose that the styletubation technique can be feasibly and routinely applied as a first-line airway modality in obese patients undergoing bariatric surgery. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and methods Results Conclusion The effects of bariatric surgery on testosterone levels in men with obesity and hypogonadism have not been thoroughly explored yet.To investigate the possible effects of bariatric surgery on T levels in obese hypogonadal men by comparing T levels before and after surgery using a comprehensive claims database.The TriNetX US Collaborative Network database was used to identify men ages 18–80 who underwent a bariatric procedure and had a serum T value of < 350 ng/dL prior to surgery. Men who received testosterone therapy before/or after surgery were excluded. We conducted a retrospective self‐matched cohort analysis to examine the difference in serum T levels before and after bariatric surgery. A sub‐analysis was carried out to explore differences between men who reached eugonadal status or maintained low T levels following surgery. Descriptive statistics detailed sociodemographic and clinical characteristics, with continuous and categorical data compared using unpaired t‐tests and chi‐square analysis, respectively. Changes in T levels and body mass index (BMI) before and after surgery were compared using an unpaired t‐test with a < 0.05 set for significance. All analyses were conducted using the TriNetX platform which utilizes both Python and R software.The study analyzed 69 hypogonadal men who underwent bariatric surgery and had T levels assessed before and after the procedure. The mean (standard deviation) pre‐surgery serum T level was 208 ± 79 ng/dL, which post‐surgery increased to 371 ± 164 ng/dL, marking an average increase of 163 ± 164 ng/dL. Likewise, the mean (standard deviation) body mass index decreased from 42.9 ± 9.0 to 38.8 ± 5.7 kg/m2. Post‐surgery, 45% (31 men) achieved eugonadal status, while 55% (38 men) continued to have low T levels. A comparison between the post‐surgery eugonadal cohort and the persistent low T cohort revealed that the former had higher pre‐surgery serum T levels (235 ± 71 ng/dL vs. 184 ± 80.4 ng/dL, p = 0.007), a higher pre‐surgery body mass index (45.5 ± 4.5 kg/m2 vs. 41.1 ± 11.5 kg/m2, p = 0.041), and a significantly greater reduction in body mass index post‐surgery (7.3 ± 7.2 kg/m2 vs. 2.0 ± 12.8 kg/m2, p = 0.04). Notably, the increase in T was significantly higher in the eugonadal cohort compared to the persistent low testosterone cohort (257 ± 143 ng/dL vs. 95 ± 178 ng/dL, p < 0.0001).This study provides evidence of bariatric surgery's positive effect on serum T levels in obese men with baseline low T. Almost one out of two men with low T reached normal T levels after bariatric surgery. As the most comprehensive study to date, it validates and substantiates previous work suggesting that weight loss can improve T levels physiologically. [ABSTRACT FROM AUTHOR]

Obesity poses significant challenges, necessitating comprehensive strategies for effective intervention. Bariatric Surgery (BS) has emerged as a crucial therapeutic approach, demonstrating success in weight loss and comorbidity improvement. This study aimed to evaluate the outcomes of BS in a cohort of 48 Uruguayan patients and investigate the interplay between BS and clinical and metabolic features, with a specific focus on FSTL1, an emerging biomarker associated with obesity and inflammation. We quantitatively analyzed BS outcomes and constructed linear models to identify variables impacting BS success. The study revealed the effectiveness of BS in improving metabolic and clinical parameters. Importantly, variables correlating with BS success were identified, with higher pre-surgical FSTL1 levels associated with an increased effect of BS on BMI reduction. FSTL1 levels were measured from patient plasma using an ELISA kit pre-surgery and six months after. This research, despite limitations of a small sample size and limited follow-up time, contributes valuable insights into understanding and predicting the success of BS, highlighting the potential role of FSTL1 as a useful biomarker in obesity. [ABSTRACT FROM AUTHOR]

Current scientific literature is deficient in detailing the optimal timing for conducting bariatric surgery in relation to kidney transplantation. In this study, we performed a retrospective evaluation of kidney transplant recipients with BMI >35 kg/m2. It aimed to provide data on those who received both sleeve gastrectomy (SG) and kidney transplantation (KT) simultaneously, as well as on patients who underwent SG and KT at different times, either before or after. In addition, the acceptance levels of the bariatric surgery among different scenarios were assessed. Our findings demonstrated that combined KT and SG led to successful weight loss, in contrast to undergoing kidney transplant alone, while maintaining comparable rates of graft and patient survival. Weight loss was similar between recipients who had a combined operation and those who underwent SG following the transplant. Additionally, over a median time frame of 1.7 years, patients who underwent SG before KT exhibited a statistically significant reduction in BMI at the time of the transplant. Notably, our study highlights that patients offered the combined procedure were significantly more likely to undergo SG compared to those for whom SG was presented at a different operative time than the transplant. [ABSTRACT FROM AUTHOR]

Bariatric surgery brings significant changes in the absorption of medications and nutrients, requiring therapeutic adjustments. After bariatric surgery, the absorption of certain medications is affected due to the reduction in gastric volume and changes in the digestive tract. It is recommended to replace solid forms with liquid solutions or orally disintegrating tablets in the first postoperative weeks. Additionally, extended)release medications should be avoided, and drugs with a narrow therapeutic index must be closely monitored. Supplementation with vitamins and minerals is essential, especially with vitamin D, calcium, iron, vitamin B12, and folate. The use of multivitamins is recommended, and patients should be periodically monitored for common deficiencies. Many chronic conditions, such as hypertension, diabetes, osteoporosis, and inflammatory diseases, require medication adjustments after bariatric surgery. Medications that predispose to weight gain, such as antipsychotics or certain antidiabetics, should be avoided, and patients should be counseled regarding the risk of alcohol abuse. [ABSTRACT FROM AUTHOR]

Background: Obesity increases the risk of developing gallstones, and this risk is further heightened by the rapid weight loss caused by bariatric surgery. Aim: to evaluate the practicality with security of doing laparoscopic cholecystectomy and sleeve gastrectomy. Patients and methods: Retrospective cohort research performed on forty-four consecutive cases who presented to Gastrointestinal Surgery Centre of Mansoura University during the period from August 2011 to August 2021. Results: None of the cases underwent conversion to open surgery, there was no intraoperative haemorrhage, there was no detected biliary injury, and blood loss was below a hundred milliliters in 95.5%. The median of hospitalization was two days, the postoperative recovery passed smoothly in most of the study population, 4.5% underwent subsequent exploration, one case had postoperative internal bleeding, and one case had gastric leakage from site of first staple. One case had postoperative subcutaneous collection, there was no port site infection, and no mortality. Conclusion: We concluded from this study that concomitant laparoscopic cholecystectomy and sleeve gastrectomy might be provided for cases with gallbladder disease as it can yield enhanced cosmetic outcomes and less postoperative discomfort and none of the cases underwent conversion to open surgery. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the test−retest reliability in lower limb muscle strength and rate of torque development (RTD) using isokinetic dynamometry in adults with obesity, with a body mass index (BMI) ≥ 35 kg/m2. Method: Thirty‐two adults with a BMI of 43.8 ± 6.6 kg/m2 eligible for bariatric surgery were enroled in the study. Isokinetic and isometric knee extensor (KE) and flexor (KF) strength were assessed in an isokinetic dynamometer (Biodex 4) during three test sessions separated by 3−7 days. Results: There were no statistical differences in peak KE and KF torque for any test modalities between sessions. Intraclass correlation (ICC) was 0.91−0.94 between sessions 1 and 2 and 0.94−0.97 between sessions 2 and 3. Standard error of measurement (SEM%) and coefficient of variation (CV) ranged across test sessions from 4.3% to 7.3%. KE RTD showed high test−retest reliability following familiarization, with ICC, CV and SEM% values ranging from 0.84 to 0.90, 13.3%−20.3% and 14.6%−24.9%, respectively. Conclusion: Maximal lower limb muscle strength measured by isokinetic dynamometry showed excellent test−retest reliability manifested by small measurement errors and low CV. Reliability was slightly improved by including a familiarization session. KE RTD but not KF RTD demonstrated high test−retest reliability following familiarization. The present data indicate that isokinetic dynamometry can be used to detect even small changes in lower limb muscle strength in adults with obesity. [ABSTRACT FROM AUTHOR]

This document serves as an introduction to the Practice Guidelines on Endoscopic Surgery, which were revised and completed in September 2019. The guidelines are intended for qualified surgeons accredited by the Japan Society for Endoscopic Surgery (JSES) and provide criteria and recommendations for endoscopic surgical procedures covered by insurance or listed as advanced medical treatments. The guidelines were developed through a standardized process involving literature search, recommendation decision, and voting. The document also provides information on the composition of the Guidelines Committee of JSES and the funding sources for the development of the guidelines. Additionally, it lists committee members and collaborators for various areas of gastrointestinal surgery, as well as committee members and experts involved in the external review of guidelines for other surgical specialties. The document includes conflict of interest and data availability statements. [Extracted from the article]

Background: One anastomosis gastric bypass (OAGB) is now the third most common bariatric surgery worldwide. This procedure is garnering increasing attention, but its complication of bile reflux and the associated risk of gastric carcinogenesis remains controversial. Objective: The study aims to assess the impact of bile reflux on the gastric mucosa by comparing pathological and immunohistochemical results of gastric mucosa before and 2 years after OAGB surgery. Methods: This retrospective study analyzed gastric lesions observed in gastroscopy before and after OAGB surgery. Pathological examinations were conducted on mucosal samples from proximal, middle and distal part of stomach, with a particular focus on the expression of Ki‐67, P53, and CDX2 in immunohistochemistry. Ki‐67 indicates cellular proliferation, P53 is a tumor suppressor protein, and CDX2 is a marker for intestinal differentiation. Results: A total of 16 patients completed the follow‐up. Regarding gastritis, presurgery nonerosive gastritis was found in two cases (12.5%), and postsurgery in six cases (37.5%). Erosive gastritis increased from one case (6.2%) presurgery to three cases (18.7%) postsurgery, totaling an increase from three to nine cases (p =.028). Bile reflux in the stomach increased from one case (6.2%) presurgery to three cases (18.7%) postsurgery. Most lesions in the proximal, middle, and distal part of stomach were relatively mild, with normal tissue states being predominant. Mild inflammation was found in all three areas, whereas moderate inflammation, intestinal metaplasia, and glandular atrophy were less common. No cases of severe inflammation were noted. The expression of gastric biomarkers CDX‐2, Ki67, and P53 showed no significant statistical variation in different areas. Conclusion: Bile reflux does occur after OAGB, but its incidence is not high. Based on the immunohistochemical and pathological results of the gastric mucosa 2 years post‐OAGB, there seems to be no significant causal relationship between OAGB and oncogenic inflammation around the gastric tube. [ABSTRACT FROM AUTHOR]

Objective: To assess perinatal cardiac function in offspring of women with previous bariatric surgery and examine its association with maternal glucose control. Design: Prospective study. Setting: Maternity unit, UK. Population: Fifty‐four fetuses/neonates; 29 of post‐bariatric surgery women and 25 of women without surgery. Methods: Prospective, longitudinal observational study of pregnant women with and without previous bariatric surgery, matched for early pregnancy body mass index. Cardiac function of all offspring was assessed by two‐dimensional conventional, spectral tissue Doppler and speckle‐tracking echocardiography at 35–37 weeks of gestation and at 5–7 weeks of age. Maternal glycated haemoglobin (HbA1c) was measured at 27–30 weeks of gestation. Maternal demographics and fetal/infant cardiac function indices were compared between the groups. Correlation coefficient (r) is reported. Main outcome measures: Fetal/infant cardiac function indices. Results: Compared with no‐bariatric neonates, offspring of post‐bariatric women were smaller at birth (birthweight centiles: 64.96 ± 36.41 versus 40.17 ± 27.99; p = 0.007). There were no significant differences in fetal/infant cardiac function indices and perinatal cardiac changes, between groups. There was a positive correlation between maternal HbA1c and fetal left ventricular (LV) longitudinal strain (r = 0.33) and LV longitudinal strain rate (r = 0.29), suggesting an inverse relation between HbA1c and fetal LV systolic function, but this was mainly seen in offspring of women with no previous bariatric surgery (r = 0.56 and r = 0.50, respectively). Conclusions: Maternal bariatric surgery does not appear to inadvertently affect the offspring cardiac performance. We found an inverse correlation between maternal HbA1c levels and fetal LV systolic function but this was mainly seen in the no‐bariatric pregnancies. [ABSTRACT FROM AUTHOR]

Summary: Preoperative depression is prevalent among patients undergoing metabolic and bariatric surgery (MBS) and is a potentially modifiable risk factor. However, the impact of preoperative depression on MBS outcomes has not been systematically reviewed. A search of MEDLINE, Embase, Cochrane, and PsychINFO (inception to June 2023) was conducted for studies reporting associations between preoperative depression and any clinical or patient‐reported outcomes after MBS. Eighteen studies (5 prospective and 13 retrospective) reporting on 5933 participants were included. Most participants underwent gastric bypass or sleeve gastrectomy. Meta‐analyses were not conducted due to heterogeneity in reported outcomes; findings were instead synthesized using a narrative and tabular approach. Across 13 studies (n = 3390) the associations between preoperative depression and weight loss outcomes at 6–72 months were mixed overall. This may be related to differences in cohort characteristics, outcome definitions, and instruments used to measure depression. A small number of studies reported that preoperative depression was associated with lower quality of life, worse acute pain, and more perioperative complications after surgery. Most of the included studies were deemed to be at high risk of bias, resulting in low or very low certainty of evidence according to the Risk of Bias In Non‐randomized Studies ‐ of Exposure (ROBINS‐E) tool. While the impact of preoperative depression on weight loss after MBS remains unclear, there is early evidence that depression has negative consequences on other patient‐important outcomes. Adequately powered studies using more sophisticated statistical methods are needed to accurately estimate these associations. [ABSTRACT FROM AUTHOR]

Summary: Objectives: This study assessed the transparency and replicability of exercise‐based interventions following bariatric surgery by evaluating the content reporting of exercise‐based clinical trials. Design: The study design of the present article is a systematic review. Data sources PubMed, Scopus, Web of Sciences, PsycINFO, and Cochrane were searched from their inception to May 2023. Eligibility criteria: Eligible studies were clinical trials including exercise interventions in participants following bariatric surgery. There were 28 unique exercise interventions. Two independent reviewers applied the exercise prescription components of Frequency, Intensity, Time, and Type (FITT; four items) and the Consensus on Exercise Reporting Template (CERT; 19 items). Exercise interventions were organized into four major exercise components: aerobic training, resistance training, concurrent training, and "others." Results: The FITT assessment revealed that 53% of the trials did not report the training intensity, whereas 25% did not indicate the duration of the major exercise component within the training session. The mean CERT score was 5 out of a possible score of 19. No studies reached CERT score >10, while 13 out of the total 19 CERT items were not adequately reported by ≥75% of the studies. Conclusion: This study highlights that the exercise interventions following bariatric surgery are poorly reported, non‐transparent, and generally not replicable. This precludes understanding the dose–response association of exercise and health‐related effects and requires action to improve this scientific field. [ABSTRACT FROM AUTHOR]

Summary: ChatGPT/GPT‐4 is a conversational large language model (LLM) based on artificial intelligence (AI). The potential application of LLM as a virtual assistant for bariatric healthcare professionals in education and practice may be promising if relevant and valid issues are actively examined and addressed. In general medical terms, it is possible that AI models like ChatGPT/GPT‐4 will be deeply integrated into medical scenarios, improving medical efficiency and quality, and allowing doctors more time to communicate with patients and implement personalized health management. Chatbots based on AI have great potential in bariatric healthcare and may play an important role in predicting and intervening in weight loss and obesity‐related complications. However, given its potential limitations, we should carefully consider the medical, legal, ethical, data security, privacy, and liability issues arising from medical errors caused by ChatGPT/GPT‐4. This concern also extends to ChatGPT/GPT ‐4's ability to justify wrong decisions, and there is an urgent need for appropriate guidelines and regulations to ensure the safe and responsible use of ChatGPT/GPT‐4. [ABSTRACT FROM AUTHOR]

Metabolic and bariatric surgeries have been shown to be the most effective strategy to induce and maintain significant weight loss for people living with severe obesity. However, ongoing concerns regarding operative risks, irreversibility and excess costs limit their broader clinical use. Endoscopic bariatric therapies are pragmatic alternatives for patients who are not suitable for metabolic and bariatric surgeries or who are concerned regarding their long‐term safety. Endoscopic sleeve gastroplasty has emerged as a novel technique of endoscopic bariatric therapies, which have garnered significant interest and evidence in the past few years. Its safety, efficacy and cost‐effectiveness have been shown in various studies, while comparisons with sleeve gastrectomy have been widely made. This review brings together current evidence pertaining to the technicality of the procedure itself, current indications, safety and efficacy, cost‐effectiveness, as well as its future role and development. [ABSTRACT FROM AUTHOR]

Background: Obesity and its related medical conditions are well-established contributors to the development of chronic kidney disease (CKD). Metabolic and bariatric surgery (MBS), including procedures such as sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), is a potential intervention for these individuals. However, the heightened risk of postoperative complications casts doubts on the suitability of MBS in this population. Our aim is to evaluate the long-term safety, anthropometric and renal outcomes of MBS in patients with CKD. Methods: A retrospective review of patients who underwent primary laparoscopic MBS with a BMI ≥ 35 kg/m2 and a preoperative diagnosis of stage 2 to 5 CKD. Criteria for CKD diagnosis and staging were based on estimated glomerular filtration rate measurements in accordance with established guidelines. Anthropometric and renal outcomes were measured at 3-, 6-, 12-, 24- and 60-months postoperatively. Results: A total of 302 patients (177 SG, 125 RYGB) were included. RYGB was preferred for patients with stage 3 CKD, while SG was more common in stages 4 and 5. At 5-year follow-up, percentage of total weight loss was higher in the RYGB cohort compared to SG (25.1% vs. 18.6%, p = 0.036). Despite SG patients having more advanced CKD, the incidence of late complications was significantly higher following RYGB, with 11 incidents (8.8%), compared to the SG cohort with only 4 cases (2.3%) (p = 0.014). In those with preoperative CKD stage 3, 76 patients (43.2%) improved to stage 2, with another 9 patients (5.1%) improving further to stage 1. Of all patients, 63 (20.8%) eventually received a successful renal transplant. Conclusions: MBS is an effective strategy for sustained weight loss in patients with CKD with acceptable complications rates. RYGB leads to a higher percentage of overall weight loss, albeit with an elevated likelihood of late surgical complications. Future studies are needed to determine the safety of MBS in this demographic. [ABSTRACT FROM AUTHOR]

Background: One-anastomosis gastric bypass (OAGB) is gaining more attention in patients with severe obesity and recently is used for patients with body mass index (BMI) < 35 kg/m2. In this 5-year single center experience we aim to report our outcomes of using OAGB for patients with BMI < 35 kg/m2. Methods: This is a retrospective analysis of prospectively collected data recorded in to our national obesity registry database. Variables including age, sex, weight, BMI, any associated disease, blood levels of metabolic markers, nutrients, and vitamins before and after surgery were extracted and analyzed. Results: 173 patients with mean age and BMI of 41 ± 10 years and 33 ± 1 kg/m2 underwent OAGB and at least one of the obesity-associated medical problems was found in 88 (50.5%) of them preoperatively. The mean duration of surgery and length of hospital stay were 60.7 ± 7.4 min and 1.3 ± 1.4 days. 78% and 70% of patients had available data at 24 and 60 months, respectively. The mean BMI was 23.9 ± 2.2 kg/m2 1 year after surgery and each year after that till 5 years was 24 ± 2, 24.4 ± 2.6, 25.1 ± 2.7, and 25.5 ± 2.7 kg/m2. Significant improvement in levels of fasting blood glucose, lipid profile, and liver enzymes were observed. Conclusion: OAGB for BMI < 35 kg/m2 has significant effects in weight loss, helps remit diabetes and hypertension in the majority of cases, improves lipid profile, and has no increased burden of postoperative problems or deficiency in nutritional factors rather than what is known and predictable. [ABSTRACT FROM AUTHOR]

Background: One anastomosis gastric bypass (OAGB) has been proposed as an effective alternative to the current standard procedure in Switzerland, Roux-en-Y gastric bypass (RYGB). Prospective data comparing both procedures are scarce. Therefore, we performed a non-inferiority randomized controlled trial assessing the effectiveness and safety of these 2 operative techniques. Method: Eighty patients were randomized 1:1. OAGB consisted of a very long gastric pouch with a 200 cm biliopancreatic limb, RYGB of a 150 cm ante-colic alimentary and a 60 cm biliopancreatic limb, respectively. Primary endpoint was the percent excess weight loss (%EWL) at 12 months after surgery. Results: Mean %EWL at 12 months was 87.9% (SD24.4) in the RYGB group and 104.1% (SD24.6) in the OAGB group (p = 0.006). There was no mortality. The rate of marginal ulcers was higher in patients with OAGB compared to those with RYGB (p = 0.011), while the total number of late complications did not statistically differ between the two groups. Except for the remission of GERD, which was higher in the RYGB group compared to OAGB, there was no difference between the groups regarding the remission of comorbidities. OAGB showed improved glucose control compared to the RYGB after 1 year (p = 0.001). Furthermore, glucagon-like peptide-1 increase was significantly higher in OAGB at 6 weeks (p = 0.041) and 1 year after surgery (p = 0.029). Quality of life improved after both surgeries, without differences between the groups. Conclusions: %EWL 1 year after surgery was higher in OAGB than in RYGB. A better glycemic control with a higher increase in GLP-1 was observed after OAGB compared to RYGB. Trial registration: This trial is registered on ClinicalTrials.gov under the identifier NCT02601092. [ABSTRACT FROM AUTHOR]

Introduction: The primary aim of this study was to evaluate outcomes associated with concurrent hiatal hernia repair (CHHR) when performing a conversional or revisional vertical sleeve gastrectomy (VSG). CHHR is often necessary during VSG due to potential gastroesophageal reflux disease (GERD) development or obstructive symptoms. Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) participant use file was assessed for the years 2015–2020 for revisional/conversional VSG procedures. The presence of CHHR was used to create two groups. Propensity score matching (PSM) was performed with E-analysis. Results: There were 33,909 patients available, with 5986 undergoing the VSG procedure with CHHR. In the unmatched analysis, there was an increased frequency of patients being female (85.72 vs 83.30%; p < 0.001), having a history of GERD (38.01 vs 31.25%; p < 0.001), and being of older age (49.59 ± 10.97 vs 48.70 ± 10.83; p < 0.001). Patients undergoing VSG with CHHR experienced decreased sleep apnea (25.00 vs 28.84%; p < 0.001) and diabetes (14.27 vs 17.80%; p < 0.001). PSM yielded 5986 patient pairs. Matched patients with CHHR experienced increased operative time (115 min ± 53 vs 103 min ± 51; p < 0.001), increased risk of postoperative pneumonia (0.45 vs 0.15%; p = 0.005) and readmission (4.69 vs 3.58%; p = 0.002) within thirty days. However, patients undergoing CHHR with revisional or conversional VSG did not experience increased risk of death, postoperative bleeding, postoperative leak, or reoperations. Conclusion: Despite a small association with increased postoperative pneumonia, the rate of complications in patients undergoing laparoscopic revisional/conversional VSG and CHHR are low. CHHR is a safe option when combined with the laparoscopic revisional/conversional VSG procedure in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: Several tools are used to assess postoperative weight loss after bariatric surgery, including the percentage of excess body weight loss (%EWL), percentage of total weight loss (%TWL), and percentage of excess body mass index (BMI) loss (%EBMIL). A repeated series of measurements should be considered to assess weight loss as accurately as possible. This study aimed to test weight loss metrics. Methods: Data were obtained from a prospective database of patients with obesity who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2016 and 2017 in a French tertiary referral bariatric center. A multilevel mixed-effects linear regression model with repeated measures was used to analyze repeated weight measurements over time. Results: A total of 435 patients underwent LRYGB (n = 266) or LSG (n = 169). At 2 years, the average %EWL, %EBMIL, and %TWL were 56.8%, 61.3%, and 26.6%, respectively. Patients who underwent LSG experienced lower weight loss (β: − 4233 in %TWL model, β: − 6437 in %EWL model, and β: − 6989 in %EBMIL model) than those who underwent LRYGB. In multivariate mixed analysis, preoperative BMI was not significantly associated with %TWL at 2 years (β, − 0.09 [− 0.22–0.03] p = 0.1). Preoperative BMI was negatively associated with both %EWL (β, − 1.61 [− 1.84–− 1.38] p < 0.0001) and %EBMIL (β, − 1.91 [− 2.16–− 1.66] p < 0.0001). Conclusion: This is the first study to assess %TWL use for postoperative weight measurement, using a multilevel mixed-effects linear regression model %TWL is the measure of choice to assess weight loss following bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: There is limited data with respect to body composition changes for laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux‐en‐Y gastric bypass (RYGB). The objective of this study was to analyse changes in body composition between these two procedures during the first year after bariatric surgery. Methods: A prospective study was performed in patients undergoing bariatric surgery at two tertiary hospitals between 2017 and 2023. Body composition was assessed with dual‐energy x‐ray absorptiometry immediately before surgery, and at 1‐, 6‐, 12‐, 18‐ and 24‐months post‐operatively, with a subgroup analysis performed for patients who undertook a scan at 18‐ and 24‐months. Total weight loss (TWL), body mass index (BMI), fat mass (FM), lean body mass (LBM) and bone mineral content (BMC) parameters were compared between SG and RYGB. Results: Forty‐five patients were included in this series (SG n = 30, RYGB n = 15). There was a significant reduction in mean %TWL of 26.94 ± 8.86% and mean BMI of 11.12 ± 3.70 kg/m2 over 12‐months. LBM accounted for 17.8% of TWL over 12‐months, SG and RYGB did not differ in terms of loss of FM or LBM. For both procedures, the loss of LBM appeared to plateau at 6‐months post‐operatively. The only statistically significant finding between the two procedures was that RYGB resulted in an additional 0.06 kg loss compared with SG. Conclusion: SG and RYGB have been shown to have comparable weight loss and body composition changes in the short‐to‐medium term following surgery. LBM reduction was most significant in the early post‐operative period across the entire cohort. [ABSTRACT FROM AUTHOR]