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Purpose: Bariatric surgery remains the most efficient treatment to achieve a sustained weight loss. However, a large proportion of patients experience suboptimal weight loss (SWL). The exact mechanisms involved remain to be fully elucidated, but the homeostatic appetite control system seems to be involved. The aim of this study was, therefore, to compare the plasma concentration of gastrointestinal hormones, and appetite ratings, between those experiencing SWL and optimal weight loss (OWL) after Roux-en-Y gastric bypass (RYGB)., Materials and Methods: Fifty participants from the Bariatric Surgery Observation Study (BAROBS) experiencing either SWL or OWL (< or ≥ 50% of excess weight loss (EWL), respectively) > 13 years post-RYGB were compared to 25 non-surgical controls. Plasma concentrations of acylated ghrelin (AG), total glucagon-like peptide-1 (GLP-1), total peptide YY (PYY), cholecystokinin (CCK), and subjective ratings of hunger, fullness, desire to eat (DTE), and prospective food consumption (PFC) were assessed in the fasting and postprandial (area under the curve (AUC)) states., Results: Those experiencing OWL presented with higher basal AG and GLP-1 iAUC, and lower AG iAUC compared with SWL and controls. Additionally, both bariatric groups presented with higher PYY and CCK iAUC compared to controls. PFC tAUC was also lower in OWL compared to the SWL group. Total weight loss was positively correlated with GLP-1 tAUC and negatively correlated with fasting and tAUC DTE and PFC tAUC., Conclusions: SWL > 13 years post-RYGB is associated with lower basal ghrelin, as well as a weaker satiety response to a meal. Future studies should investigate the causality of these associations., (© 2023. The Author(s).)

Background: It has been possible to perform colorectal operations for cancer with a laparoscopic approach for several years, but most operations are still performed by laparotomy. A systematic overview of randomized studies that compare the two techniques is presented., Material and Methods: Pubmed and Embase were systematically searched for relevant randomized clinical trials., Results: 11 randomized clinical trials were identified. Most trials showed that laparoscopic surgery for colorectal cancer was associated with significantly longer operating time (8/11), significantly less intraoperative blood loss (5/7) and a shorter hospital stay (8/10) than open surgery. There were significantly fewer complications after laparoscopic surgery in four of 11 studies. None of the studies showed any significant differences in mortality (6/6). Survival after colon cancer surgery was reported in five studies. In one case, improved disease-free survival after laparoscopic surgery was found whereas the other four showed no significant differences. Two of these studies also included rectal cancer but did not report separate data for these patients. One study that included 28 patients found no difference in cancer-related survival after laparoscopic and open surgery for rectal cancer., Interpretation: Laparoscopic surgery is an acceptable alternative to open surgery in patients with colon cancer. The procedure can be offered to patients in hospitals where experienced laparoscopic surgeons are available. In rectal cancer surgery, evidence is scarce and results from large randomized trials have to be awaited.