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Background: Although bariatric surgery is the most effective obesity treatment, few nationwide cohort studies have evaluated its safety. This study aimed to evaluate surgical trends after insurance coverage implementation and analyze the surgical outcomes of bariatric surgery. Methods: A retrospective analysis of bariatric surgery in patients with obesity was conducted using data from Korean National Health Insurance System (NHIS) claims. We evaluated short-term outcomes. Results: We enrolled 7,360 patients who underwent bariatric surgery for obesity between January 2019 and December 2021 in this study. Before the introduction of insurance coverage, approximately 500 bariatric surgeries were performed annually, which increased to around 2,000 procedures per year following the implementation of coverage. There were 5,139 sleeve gastrectomies (69.8%), 927 Roux-en-Y gastric bypasses (12.6%), 375 biliopancreatic diversions with duodenal switch (5.1%), and 895 gastric banding–related surgeries (12.2%), including revision surgeries. The mean postoperative hospital stay was 5.9 days, and patients with higher body mass indexes (≥ 50 kg/m2) experienced longer hospital stays (8.0 ± 6.4 days, p < 0.001). Major complications and mortality rates within 30 days postoperatively were 2.6% and 0.01%, respectively. The readmission rate within 30 days postoperatively was 5.5%, and the rate of major complications after readmission was 2.8% during the entire period. Conclusions: The NHIS's coverage of bariatric surgery in 2019 led to greater numbers of bariatric procedures performed in South Korea, with acceptable surgical outcomes concerning complication rates and hospital stay durations. These findings highlight the positive impact of national insurance coverage on the accessibility and safety of bariatric surgery in South Korea. [ABSTRACT FROM AUTHOR]

Background: With the rise of artificial intelligence (AI) in medical education, tools like OpenAI's ChatGPT-4 and DALL·E 3 have potential applications in enhancing learning materials. This study aims to evaluate ChatGPT-4o's proficiency in recognizing bariatric surgical procedures from illustrations and assess DALL·E 3's effectiveness in generating accurate surgical illustrations. Methods: Illustrations of six bariatric surgical procedures (One Anastomosis Gastric Bypass, Roux-en-Y Gastric Bypass, Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy, Sleeve Gastrectomy, Biliopancreatic Diversion, and Adjustable Gastric Banding) were sourced from the IFSO Atlas of Metabolic and Bariatric Surgery. ChatGPT-4 was tasked with identifying each procedure based on these illustrations to evaluate its classification accuracy. Simultaneously, DALL·E 3 was prompted with the specific names of each procedure to generate corresponding medical illustrations. Results: ChatGPT-4 correctly identified only the Adjustable Gastric Banding illustration, misclassifying the other five procedures. DALL·E 3 failed to produce accurate illustrations for all six procedures. Conclusion: The study underscores the need for further evaluation of AI in bariatric surgery. Both ChatGPT-4 and DALL·E 3, while promising, have significant limitations in recognizing and generating accurate illustrations of bariatric surgical procedures. These findings call for continued research and development to make AI models suitable for medical education applications in bariatric surgery. [ABSTRACT FROM AUTHOR]

Obesity, defined by excessive and abnormal body fat accumulation, leads to various health conditions such as diabetes, cardiovascular diseases, and certain cancers, significantly affecting the health and increasing the risk of mortality. Bariatric surgery offers a treatment for severe obesity, with restrictive and malabsorptive methods like sleeve gastrectomy (SG), adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion (BPD). While bariatric surgery is effective for weight loss and health improvement, it is not without complications. Postoperative challenges include surgical complications, bone loss, nutritional deficiencies and changes in metabolism. Post-bariatric surgery patients may face psychological challenges such as emotional dysregulation, eating disorders like loss of control eating or binge eating, and body image concerns related to excess skin. This article explores the various impacts of bariatric surgery, addressing both physical and psychological challenges. It emphasizes the importance of holistic patient care, considering both physical outcomes and mental health post-surgery, to ensure long-term success. Materials and methods The article is a result of the review of the scientific literature searched by keywords "bariatric surgery", "negative outcomes", "obesity" available in Pubmed database. This overview does not cover all possible postoperative complications in bariatric surgery, but focuses on selected issues important for a comprehensive strategy for managing obesity. Aim of the study The aim of the study is to review the various complications and long-term effects of bariatric surgery, with a particular focus on specific issues that are important for a holistic approach to obesity treatment. [ABSTRACT FROM AUTHOR]

Summary: Background: Obesity, a global health problem, is causally implicated in the development of cardiovascular disease. Bariatric surgeries are effective treatment options for obesity; however, the effectiveness of different bariatric surgeries on cardiac structure and function is not fully understood. We undertook a systematic review and network meta‐analysis to comprehensively assess this effectiveness. Data source: PubMed, Web of Science, and EMBASE were searched from their inception until November 11, 2023. Studies that compared bariatric surgeries vis‐à‐vis non‐surgical treatment, placebo, and other bariatric surgeries, as well as reported changes in left ventricular mass or its index (LVM or LVMI) or left ventricular ejection fraction (LVEF), were summarized. Results: Total 19 studies (17 cohort studies and 2 randomized controlled trials) and 2012 adults were meta‐analyzed. Patients receiving gastric bypass had appreciably lowered LVM (weighted mean difference [WMD]: −43.86 g, 95% confidence interval [CI] −61.09 to −26.63, p < 0.01) and LVMI (standardized mean difference: −0.67, 95% CI −1.03 to −0.32, p < 0.01) compared with other bariatric surgeries. No significant improvement in LVEF was noted across all surgeries. The drop in body mass index was most pronounced for biliopancreatic diversion with duodenal switch (WMD −16.33 kg/m2, 95% CI −21.60 to −11.05, p < 0.01). Conclusions: Our findings of this network meta‐analysis indicated that gastric bypass proved best for the improvement in cardiac structure, and there was no obvious improvement in cardiac function for all bariatric surgeries. Further studies are required to better understand the differing effectiveness of bariatric surgeries on cardiac structure and function and the underlying molecular mechanisms. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of biliopancreatic diversion with duodenal switch (BPD/DS) for weight loss is well established, yet there remains ongoing debate over optimal limb lengths to maximize weight loss without compromising safety. We aimed to evaluate the impact of BPD/DS limb lengths on weight loss outcomes and comorbidity resolution. Material and Methods: A multicenter review of patients who underwent primary BPD/DS between 2008 and 2022. Patient demographics, common channel (CC) length, Roux limb (RL) length, and weight loss outcomes at 6, 12, and 24 months were collected. Postoperative complications and comorbidity resolution were reported. Results: A total of 720 patients (60 with 100-cm CC/150-cm RL length, 596 with 125-cm CC/125-cm RL length, 64 with 150-cm CC/150-cm RL length) were included with a mean follow-up of 21 ± 19 months. The %TWL at 24 months was higher in the 100/150 (44.1 ± 10.3%) and 125/125 (40.6 ± 10.6%) groups compared to the 150/150 group (35.9 ± 10.8%) (p < 0.001). After adjusting for age, preoperative BMI, gender, and diabetes status, CC length was independently associated with %TWL, showing a 1.8% decrease at 24 months for every 10-cm increase in CC length (p < 0.001). The 100/150 group had higher remission rates for T2DM (p = 0.007), OSA (p < 0.001), and HTN (p = 0.036) but also higher late complications (28.5% vs. 12.5%, 7%, p < 0.001). No significant early complications were observed (p = 0.149). Conclusion: A shorter CC length of 100 cm is associated with greater weight loss and comorbidity resolution in BPD/DS patients up to 2 years after the surgery. Careful consideration of long-term risks is needed to minimize a higher prevalence of late complications. Further studies are necessary for sustained long-term weight loss outcomes. [ABSTRACT FROM AUTHOR]

Background: Use of online crowdfunding to mitigate health-related cost burden is common in the US, but its usage among candidates for metabolic and bariatric surgery (MBS) is unknown. We aimed to identify GoFundMe campaigns fundraising for MBS and characterize sources of financial strain. We also aimed to determine factors associated with successful crowdfunding. Methods: We searched GoFundMe for campaigns fundraising for MBS. Data items were extracted by two investigators with disagreements resolved by a third. We assessed associations between these data items and category of money raised using ordered logistic regression. Results: We identified 539 campaigns, of which 33.6% were raising funds for sleeve gastrectomy, 24.1% for Roux-en-Y gastric bypass, and 2.0% for biliopancreatic diversion with duodenal switch. Most campaigns were created by the patient (73.1%) who had health insurance (53.4%) and at least one obesity-associated disease (56.8%). Over half (53.6%) sought funds for a direct medical expense and 35.1% sought funds for a non-medical expense, which included lost wages (15.6%), food (10.8%), transportation (10.2%), childcare (7.1%), and/or housing (5.8%). The median requested was $8000 (IQR 10,440) and the median raised was $860 (IQR 3173). The majority (63.1%) of campaigns earned less than 25% of their requested amount. Campaigns that shared mental health-related disease (aOR 0.55, 95% CI 0.32–0.95) and non-surgical attempts to lose weight (aOR 0.59, 95% CI 0.37–0.94) had lower odds of raising a higher category of money compared to campaigns not disclosing these details. Conclusions: Patients pursuing MBS in the US use online crowdfunding to subsidize both medical and non-medical expenses, but the majority of campaigns are unsuccessful. Our study highlights unmet financial need among MBS candidates. [ABSTRACT FROM AUTHOR]

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients' management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits. [ABSTRACT FROM AUTHOR]

Summary Biliopancreatic diversion with duodenal switch (BPD‐DS) and single anastomosis duodeno‐ileostomy with sleeve (SADI‐S) are associated with superior and sustained weight loss outcomes. Despite their growing popularity, long‐term safety profiles, particularly the risk of internal hernia (IH), remain underexplored. This study aimed to evaluate the incidence and characteristics of IH following BPD‐DS and SADI‐S procedures, comparing their clinical presentation, diagnostic methods, and outcomes. A retrospective chart review was performed for patients who underwent BPD‐DS or SADI‐S between 2008 and 2023 in two high‐volume tertiary referral centres for bariatric surgery in the United States. Demographic data, comorbidities, operative details, and follow‐up outcomes were collected. A subgroup analysis of IH cases was conducted to compare the incidence, location of hernias, and diagnostic modalities between procedures. Out of 1160 patients (85.1% BPD‐DS; 14.9% SADI‐S), the overall incidence of IH was 1.12%, with a higher rate in BPD‐DS (0.8%) than in SADI‐S (0.57%). Most IHs occurred within the first 24 months postoperatively. The majority of IHs in BPD‐DS patients were in the pseudo‐Petersen's space. The single IH case in the SADI‐S group occurred in the same space. Most patients presented with abdominal pain and were diagnosed by CT imaging. SADI‐S showed a lower IH rate compared to BPD‐DS, but further studies are needed to confirm these findings. The variability in clinical presentation complicates the diagnosis of IH, emphasizing the need for increased clinical vigilance. [ABSTRACT FROM AUTHOR]

This study was designed to investigate the effects of three hypoabsorptive bariatric surgeries, namely Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), on bile acids (BAs) and to assess whether the changes in BA plasma levels were associated with the metabolic and homeostatic effects of the surgeries. Male Wistar rats, either fed a high- (HF) or a low-fat (LF) diet, were divided into seven groups: RYGB HF, BPD-DS HF, SADI-S HF, sleeve-gastrectomy (SG) HF, sham-operated (Sham) HF, Sham LF, and Sham HF-pair-weighed to BPD-DS (Sham HF-PW). The rats were treated for 56 days. The results demonstrate the ability of RYGB, BPD-DS, and SADI-S to raise plasma levels of BAs, whose elevations were likely due to changes in gene expression of transporters, enzymes, and receptors in the liver and small intestine. This increase, most notably of the secondary BAs (deoxycholic acid, ursodeoxycholic acid, and lithocholic acid), was negatively associated with body weight gain, fat gain, and fasting insulin levels, and positively with plasma peptide tyrosine-tyrosine (PYY). Plasma BAs also correlated positively with the fecal levels of Clostridium, Sutterella, and Enterobacteriaceae and negatively with Clostridiales_f_g_2, Christensenellaceae, Ruminococcaceae_g_2, Oscillibacter, and Oscillospira. In addition, they are associated positively with the short-chain fatty acid (SCFA) levels of propionate, butyrate, isobutyrate, valerate, and isovalerate. Altogether, the present study emphasizes the ability of RYGB, BPD-DS, and SADI-S to induce circulating BA elevations that predict the beneficial consequences of those hypoabsorptive bariatric surgeries on energy and glucose homeostasis and circulating levels of PYY. The present results also reveal close associations between plasma BAs and SCFAs, whose variations following hypoabsorptive surgeries are linked to significant fat losses and metabolic health improvements. NEW & NOTEWORTHY: The study emphasizes the ability of RYGB, BPD-DS, and SADI-S to induce elevated circulating bile acids levels and changes in the gene expression of transporters, enzymes and receptors in the liver and small intestine, predicting positive effects on energy and glucose homeostasis as well as PYY levels. The present results also reveal close associations between plasma BAs and SCFAs, whose variations following hypoabsorptive surgeries are also linked to significant fat losses and metabolic health improvements. These findings provide valuable insights into the mechanisms underlying the positive effects of these surgical interventions. [ABSTRACT FROM AUTHOR]

This article provides guidelines for qualified surgeons on endoscopic surgery procedures related to the stomach. It focuses on laparoscopic surgery for conditions such as gastroduodenal ulcer perforation, gastric gastrointestinal stromal tumor (GIST), gastric cancer, and gastric/esophagogastric junction cancer. The guidelines discuss the outcomes, benefits, and risks of these procedures, emphasizing the need for further research and skilled supervision. The article also mentions the use of laparoscopic gastric restrictive surgery for improving quality of life in Stage I gastric cancer patients and recommends laparoscopic gastric restrictive surgery and robotic gastrectomy for severe obesity and gastric cancer, respectively. It emphasizes the importance of adhering to specific criteria and requirements when performing these procedures. [Extracted from the article]

Abstract The single anastomosis duodeno-ileostomy with sleeve gastrectomy/single anastomosis duodenal switch (SADI-S/SADS) has gained attention as an alternative to the traditional biliopancreatic diversion with duodenal switch (BPD-DS). In 2021, IFSO endorsed SADI-S/SADS as a safe and effective procedure, underscoring the necessity for long-term multidisciplinary care and randomized controlled trials (RCTs). A task force was established to conduct a systematic review of current evidence on SADI-S/SADS to guide clinical practice. A systematic review was conducted across three databases, focusing on studies examining SADI-S/SADS and its outcomes. A total of 93 studies were analyzed. SADI-S/SADS demonstrated efficacy in weight loss and medium-to-long-term control of type 2 diabetes mellitus (T2DM), along with positive outcomes regarding hypertension and hyperlipidemia. However, its impact on other comorbidities remains inconclusive. Frequent nutritional deficiencies were identified, particularly in fat-soluble vitamins, anemia, and hypoalbuminemia. Despite significant efforts, high-quality evidence on SADI-S/SADS remains scarce, prompting IFSO to advocate for increased registry participation, publication of long-term studies, and more RCTs. Lifelong supplementation and monitoring for nutritional deficiencies are recommended. The current position statement will be reviewed in 2 years. [ABSTRACT FROM AUTHOR]

The article discusses the increasing global incidence of bariatric surgeries, focusing on advancements in surgical techniques and the need for a new classification system to better categorize modern metabolic and bariatric procedures. The proposed parametric classification divides surgeries into resectional bariatric surgeries (RBS) and non-resectional bariatric surgeries (NRBS), further subcategorized based on anatomical focus and mechanisms of action. The classification aims to guide clinicians in selecting appropriate procedures tailored to individual health needs and anatomical contexts, emphasizing the importance of anatomical modifications over traditional restrictive or malabsorptive classifications. Additionally, the article highlights the relevance of resectional gastric bypass surgeries in high-risk gastric cancer populations and the necessity for further scientific validation of the classification to address associated risks effectively. [Extracted from the article]

Background: 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. Methods: This network meta‐analysis included studies that compared the outcomes of different revisional bariatric procedures after an inadequate outcome of SG. Results: 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. Conclusion: 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]

Introduction: This randomized clinical trial evaluated the clinical outcomes of two surgical interventions for obesity treatment: single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI) and biliopancreatic diversion with duodenal switch (BPD/DS). The SADI procedure was developed as a response to the challenges posed by the BPD/DS procedure, aiming to enhance surgical efficiency, minimize postoperative risks, and maintain therapeutic efficacy. The present study primarily focused on early complications and short-term results. Methods: Fifty-six patients with a body mass index (BMI) ranging from 42 to 72 kg/m2 were randomly assigned to either the SADI or BPD/DS procedure. Parameters compared included % excess weight loss (%EWL), % total weight loss (%TWL), length of hospital stay (LOS), re-admission rates, and complications. Results: Both groups had similar demographics and baseline characteristics. SADI had a mean operating time of 109 min, significantly shorter than BPD/DS at 139 min (p < 0.001). Early complications occurred in five patients in the SADI group and in four patients in the BPD/DS group with no mortality. Median LOS was 2 days for both SADI and BPD/DS. Within 30 days, one SADI patient and three BPD/DS patients required re-admission. Serious late complications necessitating reoperation were observed in three SADI and two BPD/DS patients. After 1 year, %EWL and %TWL were similar: SADI (81.8% ± 13.6% and 40.1% ± 5.9%) and BPD/DS (84.2% ± 14.0% and 41.6% ± 6.4%). Conclusion: This trial suggests that both the SADI and BPD/DS yield comparable weight loss outcomes after 1 year, with a notable risk profile. Trial Registration: NCT 03938571 (http://www.clinicaltrials.gov) [ABSTRACT FROM AUTHOR]

The article discusses the incidental discovery of Meckel's diverticulum (MD) during bariatric surgeries, highlighting the lack of consensus on whether to resect MD during these procedures. It presents a case study of a patient with incidental MD during a bariatric procedure, where the decision not to resect the MD was made due to limited evidence and ethical considerations. The article calls for further research and expert deliberation within the obesity surgery community to establish a cohesive stance on the necessity of removing incidental MD during bariatric procedures. [Extracted from the article]

This article, published in the journal Obesity Surgery, discusses a study that examined the impact of bariatric surgery on internalized weight bias (IWB) and its relationship with weight loss. The study analyzed data from 111 participants who underwent surgery between 2013 and 2016. The findings revealed that IWB decreased after surgery, but it did not predict weight loss. The study suggests that addressing IWB should be included in the standard care for bariatric patients, and further research is needed to explore potential mechanisms and interventions to reduce IWB in this population. Please note that the data from this study are not publicly available due to privacy and ethical restrictions. [Extracted from the article]

This article provides an overview of treatment options for individuals who experience suboptimal initial response or weight regain after Roux-en-Y gastric bypass (RYGB). The prevalence of these outcomes increases over time and can reach up to 20% at 10 years. The treatment approach includes behavioral and nutritional interventions, as well as surgical and medical interventions if necessary. Medical management, particularly the use of glucagon-like peptide 1 (GLP-1) receptor agonists, has shown significant weight reductions and health improvements. Revisional metabolic bariatric surgery (MBS) is also an option but carries a higher complication rate. The article discusses various treatment options, including nutritional counseling, behavioral interventions, medical therapies, endoscopic interventions, and surgical interventions. It emphasizes the need for further research to evaluate the long-term efficacy and safety of these treatments. The document also includes a list of references covering a range of topics related to weight loss and weight regain after bariatric surgery. [Extracted from the article]

This study investigates links between CART and leptin gene expression, FSH receptor Asn680Ser polymorphism, and reproductive hormones in morbidly obese patients under 40 years old, facing infertility, and undergoing bariatric surgery. A total of 29 women were included in this study. A hormonal profile along with detection of CART and leptin gene expression was evaluated before and after bariatric surgery. Additionally, the presence or absence of Asn680Ser of the FSHR gene was studied. Following bariatric surgery, a mean reduction in BMI (16.03 kg/m2) was observed in all women. FSH levels preoperatively varied significantly among genotypes, with medians of 8.1, 9.5, and 10.3 for individuals without polymorphism, heterozygotes, and homozygotes, respectively (p = 0.0408). Post surgery, marginal differences in FSH levels were observed (5.8, 7.1, and 8.2, respectively) (p = 0.0356). E2 and LH levels exhibited no significant genotype-based differences pre and post surgery. Presurgical E2 levels were 29.6, 29.8, and 29.6, respectively (p = 0.91634), while postsurgical levels were 51.2, 47.8, and 47 (p = 0.7720). LH levels followed similar patterns. Our findings highlight bariatric surgery's positive impact on BMI reduction and its potential connection to genetic markers, hormones, and infertility. This suggests personalized treatments and offers a valuable genetic tool for better fertility outcomes in obese individuals. [ABSTRACT FROM AUTHOR]

Background: Obesity is a well-known risk factor for gastroesophageal reflux disease (GERD). Even though symptoms may be mitigated or resolved with the weight loss caused by sleeve gastrectomy (SG), it may be associated with higher incidences of postoperative GERD. Ligamentum teres cardiopexy (LTC) is an alternative to Roux-en-Y gastric bypass, the gold standard treatment for GERD. Methods: This study was a retrospective single-center chart review, all patients in this cohort underwent LTC to treat refractory GERD at our institution. The option for LTC was presented after patients' refusal to undergo RYGB conversion. We collected baseline characteristics, standard demographics, pre-operative tests and imaging, and SG information, as well as intraoperative and perioperative data regarding LTC, and postoperative complications. Results: Our cohort included 29 patients; most were Caucasian (44.8%) females (86.2%). The mean weight and BMI before LTC were 216.5 ± 39.3 lb and 36.1 ± 5.4 kg/m2, respectively. Mean total body-weight loss (TBWL) at 12 and 24 months were 28.7% ± 9.5% and 28.4% ± 12.4%, respectively. The mean interval between the index bariatric surgery and LTC was 59.9 ± 34.9 months, mean operative time was 67 ± 18.2 min, and median length of stay (LOS) was 1 day (IQR = 1–2 days). Twelve patients (57.1%) were able to discontinue antisecretory medications, while 9 (42.9%) still required them to remain asymptomatic. Mortality and reoperation rates were 0% and the incidence of complication was 19.4% (n = 6). Conclusions: LTC is a safe and effective surgical alternative to treat refractory GERD symptoms after SG. [ABSTRACT FROM AUTHOR]

Background: Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective and durable metabolic and bariatric surgery to achieve a target weight loss. However, many surgeons are hesitant to adopt BPD-DS due to a lack of training, technical complexity, and long-term nutrition deficiencies. This meta-analysis aimed to investigate long-term nutrition outcomes after primary BPD-DS in the management of obesity. Methods: Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to February 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42023391316). Results: From 834 studies screened, 8 studies met the eligibility criteria, with a total of 3443 patients with obesity undergoing primary BPD-DS. At long-term follow-up (≥5 years), 25.4% of patients had vitamin A deficiency (95% CI: -.012,.520, I2 = 94%), and 57.3% had vitamin D deficiency (95% CI:.059, 1.086, I2 = 86%). Calcium deficiency was observed in 125 patients (22.2%, 95% CI:.061,.383, I2 = 97%), and 69.7% had an abnormal parathyroid hormone level (95% CI:.548,.847, I2 = 78%). Ferritin level was abnormal in 30 patients (29.0%, 95% CI:.099,.481, I2 = 79%). Conclusions: Despite displaying comparable nutrition-related outcomes to mid-term follow-up, our study demonstrated that BPD-DS could result in a high level of long-term nutrition deficiency after BPD-DS for selected patients. However, further randomized controlled studies with standardized supplementation regimens and improvement in compliance are necessary to evaluate and prevent long-term nutritional deficiencies after BPD-DS. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread clinical use of hypoabsorptive metabolic bariatric surgery, very long-term outcomes are still lacking. The aim of the study was to assess the long-term safety and efficacy of biliopancreatic diversion at 30 years in patients with class 3 obesity (BMI over 40 kg/m2). Methods: This retrospective single-centre study used data from a prospectively collected database on a sample of consecutive patients submitted to biliopancreatic diversion with a minimum follow-up of 30 years. Outcomes assessed included overall survival, long-term weight loss and weight maintenance, remission of obesity-related co-morbidities, and short- and long-term surgical and/or nutritional or metabolic complications. Results: Among 199 consecutive patients (136 female, 63 male) who had surgery between November 1992 and April 1994, the mean age at operation was 38 (range 14–69) years and mean preoperative BMI was 48.7 (32.0–74.3) kg/m2. At baseline, 91 of 199 patients (45.7%) had type 2 diabetes. At 20 and 30 years, 122 (61%) and 38 (19%) of the 199 patients respectively were available for follow-up. At 30 years, the overall mortality rate was 12% (23 of 199). Surgical complications were concentrated in the short-term follow-up, whereas nutritional or metabolic complications increased progressively over time. A nutritional complication was diagnosed in 73 of 122 patients (60%) at 20 years and 28 of 38 (74%) at 30 years. Weight loss and glycaemic control were maintained throughout the follow-up; mean % total weight loss was 32.8 (range 14.1–50.0) at 1 year and 37.7 (range 16.7–64.8) at 30 years. One patient presented with recurrence of type 2 diabetes at 20 and 30 years; there were no patients with new-onset type 2 diabetes. Conclusion: Biliopancreatic diversion leads to good and sustained weight maintenance up to 30 years with low perioperative risk, but at the cost of a high long-term prevalence of nutritional complications. This study analysed the efficacy and safety of biliopancreatic diversion in patients with severe obesity who underwent surgery, with a minimum follow-up of 30 years. Long-term weight maintenance was excellent, but there was a high incidence of complications. These results are a warning for all malabsorptive bariatric surgical procedures with shorter follow-up. [ABSTRACT FROM AUTHOR]

Obesity and obesity-related conditions today constitute a public health problem worldwide. Obesity is an "epidemic" chronic disorder, which is defined by the WHO as normal or excessive fat accumulation that may impair health. It is also defined for adults as a BMI that is greater than or equal to 30. The most common obesity-related diseases are type 2 diabetes mellitus, cardiovascular diseases, metabolic syndrome, chronic kidney disease, hyperlipidemia, hypertension, nonalcoholic fatty liver disease, and certain types of cancer. It has been also proven that obesity can have a negative effect on hair. It can lead to hair thinning. Patients with obesity can undergo bariatric surgery if they meet the inclusion criteria. The four common types of weight loss surgery include a duodenal switch with biliopancreatic diversion, laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, and sleeve gastrectomy. Bariatric surgery can affect skin and hair and is associated with telogen effluvium due to weight loss, microelement deficiency, anesthesia, low calorie intake, and low protein intake. Patients who undergo bariatric surgery can experience post-bariatric surgery depression. Hair loss can have a major impact on self-esteem, negatively affecting one's self-image. The purpose of this narrative review is to critically review how obesity, obesity-related diseases, and bariatric surgery affect hair health in general and the hair development cycle, and how they influence hair loss. [ABSTRACT FROM AUTHOR]

Background: Untreated pancreatic exocrine insufficiency (PEI) results in substantial patient harm. Upper gastrointestinal surgery (bariatric metabolic surgery and oesophagogastric resection) affects the delicate physiology of pancreatic exocrine function and may result in PEI. The aim of this study was to assimilate the literature on incidence, diagnosis, and management of PEI after bariatric metabolic surgery and oesophagogastric resection. Methods: A systematic review of PubMed, MEDLINE, and Embase databases identified studies investigating PEI after non-pancreatic upper gastrointestinal surgery. Meta-analyses were undertaken for incidence of PEI and benefit of pancreatic enzyme replacement therapy. Results: Among 1620 patients from 24 studies included in quantitative synthesis, 36.0% developed PEI. The incidence of PEI was 23.0 and 50.4% after bariatric metabolic surgery and oesophagogastric resection respectively. Notably, the incidence of PEI was 44% after biliopancreatic diversion with duodenal switch and 66.2% after total gastrectomy. The most common diagnostic test used was faecal elastase 1 (15 of 31 studies), with less than 200 µg/g being diagnostic of PEI. A total of 11 studies considered the management of pancreatic exocrine insufficiency, with 78.6% of patients responding positively to pancreatic enzyme replacement when it was prescribed. Conclusion: PEI is common after non-pancreatic upper gastrointestinal surgery and patients may benefit from enzyme replacement therapy. The aim of this study was to carry out a systematic review and meta-analysis of pancreatic exocrine insufficiency after non-pancreatic upper gastrointestinal surgery. The incidence of pancreatic exocrine insufficiency was 50.4 and 23.0% after oesophagogastric resection and bariatric metabolic surgery respectively. Of studies reporting the benefit of pancreatic enzyme replacement therapy, 78.6% of patients reported symptomatic improvement. Pancreatic exocrine insufficiency reduces quality of life, and contributes to malnutrition and long-term poor health. More research is needed to define the harm of pancreatic exocrine insufficiency and the benefit of enzyme replacement therapy in these cohorts. Lay Summary: Pancreatic exocrine insufficiency occurs when enzymes from the pancreas are unable to help digest food. Pancreatic exocrine insufficiency is known to cause disruptive symptoms after gastrointestinal surgery. Although such symptoms are well known after pancreatic surgery, after other gastrointestinal operations, including bariatric metabolic surgery and oesophagogastric cancer resection, pancreatic exocrine insufficiency is often overlooked as a cause of both symptoms and poor nutrition. This study looked at, and combined, all the current evidence on the rate of pancreatic exocrine insufficiency after these operations, the way it is diagnosed, and how it is treated. Pancreatic exocrine insufficiency may be more common than previously thought after bariatric metabolic surgery or oesophagogastric surgery, and clinicians working with these patients should have a low threshold for starting treatment. [ABSTRACT FROM AUTHOR]

Introduction: Biliopancreatic diversion with duodenal switch (BPD/DS) is an uncommon type of bariatric surgery that can rarely lead to bleeding in the biliopancreatic limb. The altered anatomy poses significant diagnostic and therapeutic challenges. Case Presentation: We present an unusual case of a woman status post-BPD/DS nearly a decade ago who presented with gastrointestinal bleeding in the duodenum of the biliopancreatic limb, a rare phenomenon given the unique surgery. Conclusion: We illustrate a promising minimally invasive option of successfully treating the bleeding by interventional radiology (IR) embolization as an alternative to more invasive and challenging options of balloon-assisted enteroscopy, lumen-apposing metal stent placement and surgical intraoperative enteroscopy. [ABSTRACT FROM AUTHOR]

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We reviewed the literature on the prevalence of small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB). Eight studies examining 893 patients were included. The mean age of the patients was 48.11 ± 4.89 years. The mean BMI before surgery and at the time of SIBO diagnosis was 44.57 ± 2.89 kg/m2 and 31.53 ± 2.29 kg/m2, respectively. Moreover, the results showed a 29% and 53% prevalence of SIBO at < 3-year and > 3-year follow-up after RYGB, respectively. Symptoms included abdominal pain, diarrhea, bloating, nausea, vomiting, constipation, soft stool, frequent defecation, flatulence, rumpling, dumping syndrome, and irritable bowel syndrome. SIBO is prevalent after RYGB; digestive symptoms should prompt the consideration of SIBO as a potential etiology. Antibiotic therapy has proven to be therapeutic. [ABSTRACT FROM AUTHOR]

Obesity significantly increases the risk of developing metabolic and cardiovascular diseases. The most effective management tool for both obesity and type 2 diabetes (T2D) is bariatric/metabolic surgery. Delayed postprandial plasma triglyceride clearance contributes to the development of atherosclerosis in patients with T2D. Biliopancreatic diversion (BPD) was shown to be the most effective procedure in long-term T2D remission. However, the effect of BPD on postprandial metabolic profile has not been studied so far. In this pilot study, we therefore examined the changes in postprandial glucose, insulin, and triglyceride in women with severe obesity and T2D before surgery and then two and ten years after BPD. The studied cohort included 7 women (mean age at baseline=49.3±8.2 years) with severe obesity (mean BMI=45.7±2.9 kg/m²) and T2D. A standardized liquid mixed-meal test was carried out in all subjects and the mean postprandial levels of plasma glucose, insulin, and triglyceride were analyzed by standard laboratory procedures. For statistical evaluation, ANOVA with Bonferroni multiple comparisons was used. Ten years after BPD not only a significant reduction of an average BMI (F=32.9, p<0.001) but also significant declines in mean postprandial plasma levels of glucose (F=155.3, p<0.001), insulin (F=69.8, p<0.001), and triglyceride (F=139.9, p<0.001) were demonstrated. The observed changes in postprandial metabolic profile may contribute to improved cardiometabolic health after bariatric surgery. [ABSTRACT FROM AUTHOR]

Background: Obesity is related to cardiovascular risk factors (CVRF) such as dyslipidemia, diabetes, and hypertension, which increase mortality. Basic lipid determinations could underestimate the true atherogenic risk of patients and the impact of bariatric surgery. The objective of the study is to demonstrate the change in the advanced molecular profile of lipoproteins determined by nuclear magnetic resonance spectroscopy in plasma after bariatric surgery, thus reducing the risk of cardiovascular disease. Material and Methods: Descriptive, observational, and prospective study in obese patients undergoing bariatric surgery. Advanced lipid profile was analyzed in plasma from the immediate preoperative period and at the 18th postoperative month by sending samples and performing plasma magnetic resonance spectroscopy in the BiosferTreslab® laboratory. Results: Fifty-two patients were included. Average age of 46.3 years; 63.46% were women, 36.54% men. The average BMI was 43.57; the abdominal perimeter 133.50 cm; 32.6% were diabetics under medical treatment, 44.23% hypertensive, and 19.23% smokers; 86.53% of the patients presented alterations in at least one of the analytical parameters in the lipid study. Twenty-nine (55.7%) underwent banded gastric bypass (PGB), 19.23% underwent GBP, and 17.31% vertical gastrectomy. The rest were revision surgeries, two BPG-A and two biliopancreatic diversions after GV. All patients presented some improvement in advanced molecular profile of lipoproteins. Twenty percent of the patients normalized all the parameters. Conclusions: Bariatric surgery improves advanced molecular profile of lipoproteins, decreasing CVRF. Analysis of the characteristics of lipoprotein particles by NMR spectrometry is optimal for studying lipoprotein metabolism in patients undergoing bariatric surgery. [ABSTRACT FROM AUTHOR]

Introduction: The role of the common channel length in duodenal switch (DS) on remission of type II diabetes mellitus (DM), when stratifying patients based on diabetes severity, is not well understood. Methods: We retrospectively reviewed 341 consecutive patients with DM undergoing DS with one of three different common channel (CC) lengths (100 cm, 150 cm, and 200 cm), each with a fixed 300 cm alimentary limb (AL). Patients were stratified by insulin dependence (IDDM) versus non-insulin dependent diabetes (NIDDM). Data was collected at one year and at the last available follow-up. Results: The NIDDM group had a similar average HbA1c at last follow-up for each of the CC lengths. However, the IDDM group had lower average HbA1c with shorter CC lengths (100 cm = 5.4%, 150 cm = 6%, 200 cm = 6.4%, p < 0.05). Shorter CC lengths resulted in a greater proportion of patients achieving remission in the IDDM group (66%, 50%, 32% in the 100 cm, 150 cm, and 200 cm CC, respectively, p < 0.01). Improvements in HbA1c were independent of weight loss and average DiaRem scores were similar between CC lengths. Rates of nutritional deficiencies were higher in shorter common channel lengths. Revision for malnutrition was similar between common channel lengths (100 cm group: 3.7%; 150 cm group: 1.8%; 200 cm group: 0%, p = NS). Conclusions: When the AL is fixed, shortening CC lengths results in improved glycemic control and remission of DM in patients with the need for insulin preoperatively. Milder forms of DM are treated well with any of the CC lengths. [ABSTRACT FROM AUTHOR]

Introduction: The current obesity epidemic is accompanied by an increasing use of obesity surgery. However, the French health care system struggles to ensure long-term follow-up of these patients, for which the general practitioner plays a crucial role. Objective: Based on a literature review, to develop a monitoring tool in order to improve patient follow-up care after obesity surgery, by optimizing the coordination between general practitioner and the referral Obesity center team. Methods: Methodology of the French National Authority for Health to develop a memo sheet, supported by a systematic review, validated by the expertise of a task group. Results: Obesity surgery, yet effective on severe obesity and its comorbidities, can expose to the risk of severe postoperative complications, adverse psychosocial impact, or weight regain, which is feared. Nutritional deficiencies are frequent, and a lifelong micronutrient supplementation is essential (multivitamin and mineral complex, vitamin D-calcium, iron, vitamin B12); otherwise, the deficiency could lead to complications (e.g. hematological, neurological, musculoskeletal). Their prevention-screening-treatment are part of a global interdisciplinary postoperative management, including medical and biochemical monitoring, behavior change strategies in eating and exercise habits, and psychological support. The learned societies recommend to strengthen the collaboration between general practitioners and surgical teams. The "BARIA Check" sheet has synthesized these key data in order to guide the general practitioner to ensure this mission, in coordination with the referral obesity centre. Conclusion: Complications after obesity surgery need to be prevented to ensure its long-term safety and effectiveness. General practitioners supported by "BARIA Check" will contribute to this achievement. [ABSTRACT FROM AUTHOR]

Wernicke encephalopathy (WE) is an acute neurological disorder classically characterized by ataxia, ophthalmoplegia, and altered mental status. This is caused by thiamine deficiency and is usually seen in malnourished populations. However, with the advent and rise of bariatric surgery in the last 50 years, WE has become an increasingly recognized and potentially deadly complication. Here, we review the populations at risk, clinical presentation, and the incidence of WE in the bariatric surgery population from 1985 to 2023. While the predominant procedure shifts throughout the years, the overall incidence of WE per 100,000 cases for the following procedures are sleeve gastrectomy (1.06), gastric band (1.16), RYGB (4.29), and biliopancreatic diversion with duodenal switch (8.92). Thus, early intervention and post-operative supplementation is recommended to prevent WE. [ABSTRACT FROM AUTHOR]

Purpose: Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. Methods: A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. Results: Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller's myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. Conclusion: In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success. [ABSTRACT FROM AUTHOR]

Systemic insulin sensitivity is increased by the energy storage demand of the body and is decreased by a fall in demand. Insulin resistance is a negative feedback response to energy excess in cells. Bariatric surgery removes the energy excess and induces a persistent energy deficit; this underlies the improvement of insulin sensitivity and the remission of type 2 diabetes. The surgery-induced energy deficit is responsible for both weight loss-dependent and weight loss-independent insulin sensitization. The energy deficit corrects mitochondrial overloading in multiple cell types to restore relevant tissue functions, leading to type 2 diabetes remission. Bariatric surgery is a powerful therapy for type 2 diabetes in patients with obesity. The mechanism of insulin sensitization by surgery has been extensively investigated in weight loss-dependent and weight loss-independent conditions. However, a consensus remains to be established regarding the underlying mechanisms. Energy deficit induced by calorie restriction (CR), that occurs both before and after surgery, represents a unique physiological basis for insulin sensitization regardless of weight loss. In support, we integrate evidence in the literature to provide an energy-based view of insulin sensitization as follows: surgery improves insulin sensitivity through the energy deficit induced by CR, leading to correction of mitochondrial overload in multiple cell types; this then triggers functional reprogramming of relevant tissues leading to diabetes remission. [ABSTRACT FROM AUTHOR]

The long-term results after biliopancreatic diversion (BPD) in patients with type 2 diabetes (T2D) and severe obesity is still being debated. Retrospective evaluation of the long-term metabolic and clinical conditions of patients with T2D following BPD. University hospital. A total of 173 patients with T2D and severe obesity were investigated prior to and at 3–5 and 10–20 years after BPD. Anthropometric, biochemical, and clinical findings preoperatively and throughout follow-up were considered. The long-term data were compared with those of a cohort of 173 T2D patients with obesity treated with conventional therapy. T2D resolved within the first postoperative phases in most patients, and in the long and very long term, the fasting blood glucose level remained above the normal range in only 8% of patients. Likewise, a stable improvement of blood lipid pattern was observed (follow-up rate 63%). In contrast, in nonsurgical patients in the long term, the glucose and lipid metabolic parameters remained in the pathologic range in all cases. In the BPD group, a very high number of severe BPD-related complications was recorded, and 27% of the BPD patients died, whereas in the control group, 87% of patients were still alive at the end of the follow-up period (P <.02). Despite the high T2D stable resolution rate and the normalization of most metabolic data at 10–20 years following surgery, these results indicate that BPD should be indicated with caution in the surgical treatment of T2D in patients with severe obesity. [ABSTRACT FROM AUTHOR]