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BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is an effective treatment for obesity. However, the incidence and long-term risk of hypoglycemia after surgery in patients without diabetes remains unclear. This study aimed to investigate the prevalence of hypoglycemia following RYGB surgery in patients with obesity and without diabetes. METHODS: A retrospective cohort study was conducted using the TriNetX database. The study population included 15,085 patients with obesity (BMI ≥ 30 kg/m2) who underwent RYGB surgery and 3,200,074 non-surgical controls, all without a history of diabetes or GLP-1 receptor agonist use. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of hypoglycemia, defined by ICD-10-CM codes or laboratory values (glucose ≤ 70 mg/dL). Cox regression analysis was employed to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: In the overall study population, the risk of hypoglycemia was significantly higher in the RYGB group (18.70%, n = 2,810) compared to the control group (3.80%, n = 120,923; HR 4.3, 95% CI 4.14-4.46, p

Although rare, internal hernias have an increased incidence of development in patients who have undergone Roux-en-Y gastric bypass. They are difficult to diagnose given their non-specific presentation and lack of externally visible findings, and most cases develop within a few months of the original procedure. In this case report, we present a patient with recent weight loss who developed an internal hernia decades post-bariatric surgery with computed tomography findings showing the classic "mesenteric swirl" sign.

Roux-en-Y gastric bypass (RYGB) is a commonly used surgery to successfully and durably treat obesity that is increasingly performed robotically. The anastomoses created during robot-assisted RYGB are usually stapled, either using laparoscopic or robotic staplers. This study aimed to compare the peri-operative efficiency, costs, and clinical outcomes of laparoscopic and robotic staplers in robot-assisted RYGB. This retrospective study analyzed patients who underwent robot-assisted RYGB (with or without hiatal hernia repair) with the Da Vinci Xi robotic system in a private practice in the United States. The gastric pouch and anastomoses were created either with robotic SureForm™ staplers or laparoscopic Endo GIA™ staplers; enterotomies and incisions were closed with sutures. The primary outcome was procedure time. The secondary outcomes were instrument exchanges and reloads used, stapling costs, length of stay, and complications within 3 months. Of the 105 patients included, 50 patients were treated with robotic staplers and 55 with laparoscopic staplers. None were lost to follow-up. Laparoscopic staplers were more efficient than robotic ones: they significantly reduced procedure times across all analyzed categories as well as the number of instrument exchanges and reloads needed per surgery. There was no difference in the length of hospital stay, and no complications were reported. The higher number of reloads and the higher unit cost resulted in higher total stapling costs for robotic compared to laparoscopic staplers. While robotic staplers in robot-assisted RYGB are safe and feasible, laparoscopic staplers improve efficiency, reduce resource use, and lower costs without compromising patient safety. [ABSTRACT FROM AUTHOR]

Background: Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be indicated for patients due to insufficient weight loss or weight regain. Objectives: To assess weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients. Setting: University Hospital. Methods: Retrospective review of patients who underwent conversion from SG to RYGB from 2015 to 2022 was performed, assessing pre-and post-operative weights for each procedure. Results: 114 patients were included (84% female, pre-SG BMI 49.3 ± 10.2). Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6–58.2] ± 10.1%), %EWL of 56.8%([13.3–97.3] ± 16.4%), and total body weight regain of 53.9%([0.0–144.4] ± 31.3%). Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, leveling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m2 increase yielded 0.8% greater %TBWL [95% CI 0.5–1%, p < 0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9–7.1%, p < 0.0001). Conversely, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5–5.7%, p < 0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB. Conclusions: Conversion from SG to RYGB is effective for further weight loss. Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after SG demonstrate the most effective weight loss post-conversion. [ABSTRACT FROM AUTHOR]

Background: Research on the use of prophylactic inferior vena cave filter (IVCF) placement prior to metabolic and bariatric surgery (MBS) in high risk patients has yielded conflicting results. We evaluated thrombotic events and mortality in patients with a history of venous thromboembolism (VTE) who underwent IVCF placement in anticipation of MBS. Methods: We queried the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database for all patients undergoing primary sleeve gastrectomy or Roux-en-Y gastric bypass from 2015 to 2019 with a history of VTE. We tabulated yearly IVCF use and compared 30-day rates of deep venous thrombosis (DVT), pulmonary embolism (PE), readmission, mortality, and serious adverse events in patients with and without prophylactic IVCF placement. Multivariate logistic regression was used to assess the relationship between preoperative placement of an IVCF and postoperative outcomes. Results: Of 754,397 patients undergoing MBS, 16,683 (2.2%) had a prior VTE. Placement of IVCF in anticipation of MBS decreased from 285/2245 (10.4%) in 2015 to 85/3750 (2.2%) in 2019 (p < 0.01). The incidence of PE did not differ significantly between patients with prophylactic IVCF vs. those without (0.1% vs 0.5%, p = 0.13). Postoperative DVT was more common in patients who underwent IVCF placement (1.7% vs. 0.8%, p < 0.01). No significant differences were observed in mortality. Preoperative placement of an IVCF was an independent risk factor for development of a postoperative DVT (OR 2.45; 95% CI 1.39–4.32). Conclusions: These data do not support a history of VTE as an indication for prophylactic IVCF placement in anticipation of MBS. [ABSTRACT FROM AUTHOR]

Context: Post‐bariatric hypoglycemia (PBH) is a complication of bariatric surgery including Roux‐en‐Y gastric bypass (RYGB). It remains unclear why only some individuals develop PBH. Objective: To identify clinical characteristics distinguishing post‐RYGB individuals with PBH, versus without symptomatic hypoglycemia (RYGB non‐hypo). Design and Setting: Cross‐sectional observational study in academic referral centre. Adults 18–70, without current diabetes, were recruited into three groups: (1) PBH (n = 39); (2) RYGB non‐hypo (n = 25); and (3) individuals without history of upper gastrointestinal surgery (n = 17). Outcome measures included between‐group differences in medical history and medication use, and survey‐based scores for hypoglycemia, dumping syndrome, and autonomic symptoms. Results: PBH participants were 92% female, age 53.4 ± 11.9 y, BMI 31.2 ± 5.6 kg/m2, versus RYGB non‐hypo (100% female, age 53.2 ± 10.5 y, BMI 32.2 ± 8.0 kg/m2) and controls (65% female, age 44.5 ± 14.6 y, BMI 30.8 ± 6.3 kg/m2). 87% of PBH reported level 3 hypoglycemia, with emergency visits in 28% and vehicle accidents in 8%. Reduced hypoglycemia awareness was reported by 82%; 13%–17% were classified as unaware (modified Clarke/Gold scores). Preoperative hypoglycemia symptoms and family history were reported by 26% and 18% of PBH. PBH had significantly higher survey scores for hypoglycemia, dumping syndrome, and autonomic symptoms, and higher self‐reported neuropathy, autonomic neuropathy, orthostatic hypotension, reflux esophagitis, intestinal dysmotility, and IBS (all p < 0.05 vs. RYGB non‐hypo). Gabapentin and PPI use was more frequent in PBH. Conclusion: High rates of IBS, dumping symptoms, and orthostatic hypotension suggest disordered autonomic regulation as a potential contributor to PBH. Self‐reported preoperative symptoms and family history of hypoglycemia suggest possible preoperative differences in glucose metabolism in PBH. [ABSTRACT FROM AUTHOR]

Summary: Parallel to the increasing number of patients with obesity and metabolic syndrome, the number of bariatric procedures is rapidly growing. Gastric bypass is the surgery of choice due to its high efficiency and safety profile; however, subsequent assessment and surveillance of the excluded stomach poses considerable challenges. Gastric remnant cancer is a rare entity and only a few cases have been published in the literature. Here, we report the first case of a human epidermal growth factor receptor 2-positive gastric cancer in the excluded remnant in a 58-year-old man with a history of bariatric Roux-en‑Y gastric bypass surgery. This case highlights the challenge of cancer surveillance in the eliminated stomach and chemotherapeutic treatment after bariatric surgery. Furthermore, we address the efficacy of trastuzumab deruxtecan as a second-line therapy in HER2-positive gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications. Methods: This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication. Results: Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population. Conclusion: There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients. [ABSTRACT FROM AUTHOR]

Introduction: Roux-en-Y gastric bypass (RYGB) related late gastro-jejunal (GJ) strictures are often resistant to endoscopic balloon dilations. Lumen-apposing metal stents (LAMSs) have been used to treat benign strictures with favorable results. However, the data remains limited to justify LAMS use for management of post-RYGB late GJ strictures. We aim to evaluate the safety and efficacy of LAMS placement for the management of late GJ strictures that are refractory to balloon dilations in post-RYGB patients. Methods: This was a single center retrospective study that included all post-RYGB patients who underwent LAMS placement for management of late GJ strictures that had previously failed balloon dilations. Primary outcomes were technical and clinical success, and secondary outcomes were LAMS-related adverse events. Results: A total of 28 patients underwent LAMS placement for management of GJ strictures. Median age was 60.5 (IQR 50.5, 67.0) years and majority were females (27, 96.4%). Median interval between surgery and first diagnosis of GJ stricture was 13 years (IQR 7, 17.5). 20 × 10 mm LAMS was the most used stent (n = 24, 85.7%). The median procedure time was 23.5 (IQR 14.5, 32.0) minutes. Technical and short-term clinical success of LAMS placement was 100% (95% CI 87.9–100.0). Long-term success was achieved in 19 out of 25 patients (76.0%, 95% CI 56.6–88.5) that had over 3 months follow-up after LAMS removal. Stent migration was noted in 2 (7.1%) patients, and 1 (3.6%) patient each experienced pain and minor bleeding without the need for additional interventions. No patient in our cohort required surgical revision of GJ anastomosis. Conclusion: Placement of LAMS is safe, technically feasible, and associated with a high clinical success rate in patients with late GJ strictures after RYGB who have failed prior balloon dilations. Placement of LAMS can be considered early in patients requiring multiple balloon dilations. [ABSTRACT FROM AUTHOR]

Background: Long-term data on the likelihood of undergoing additional related operations after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remain scarce. Objectives: The aims of this study are to identify the long-term incidence of bariatric related operations, patient's predictive factors, and most common operations in the 15–20 years following LRYGB. Setting: Single Academic Institution, Center of Bariatric Excellence. Methods: We performed a retrospective analysis of all LRYGB performed at Single Institution from 2003 to 2008. All subsequent bariatric related operations performed were manually reviewed, excluding upper endoscopies. Kaplan–Meier analysis was utilized to estimate the time to procedure. Cox regression was used to determine patient's factors associated with time until procedure. Results: Of the 665 patients included, the median follow-up was 14 years. There were 248 (37.3%) patients with a related operation. After excluding panniculectomy, 199 (29.9%) had a related operation. The 3 most common operations were panniculectomy [n = 77 (12%)], followed by cholecystectomy [n = 64 (10%)], and internal hernia repair [n = 56 (8%)]. The Kaplan–Meier estimated incidence of related operation at 15 years was 43.7% and 35.3% after excluding panniculectomy. Females (HR = 1.77, 95% CI = [1.20, 2.62, p = 0.0039), age < 50 (HR = 1.42, 95% CI = [1.07, 1.88], p = 0.014), and BMI > 60 (HR = 2.77, 95% CI = [1.30, 5.91], p = 0.0083) were more likely to have a related operation. Conclusion: Bariatric related operations are common after LRYGB. Nearly half of patients will eventually undergo a secondary operation as they approach 20 years post-LRYGB. [ABSTRACT FROM AUTHOR]

Background: One-Anastomosis Gastric Bypass (OAGB) is becoming popular, but some patients may need to convert to Roux-en-Y Gastric Bypass (RYGB) due weight-related difficulties or postoperative complications. The data on conversions is currently limited to 30-day or short-term follow-up studies. As such, the objective of this study was to evaluate the indications and mid-term outcomes for OAGB conversions to RYGB at a tertiary referral center in the United Arab Emirates. Methods: A retrospective analysis was conducted on patients who underwent conversion from OAGB to RYGB between February 2016 and May 2023. Demographic information, indications for conversion, intraoperative details, and mid-term outcomes were collected and analyzed. Results: Sixty-four patients underwent conversion from previous OAGB to RYGB. The cohort was 73.4% female (n = 47) with a mean age of 40.8 years. Indications for conversion included acid reflux (n = 28, 43.7%), intractable nausea/vomiting (n = 20, 31.2%), protein-calorie malnutrition (n = 7, 10.9%), anastomotic ulcer (n = 6, 9.3%) and weight recidivism (n = 3, 4.7%). The mean operative time was 238 ± 78.3 min. During the procedure, three intraoperative complications occurred: two cases of bleeding and one case of bowel perforation; all successfully addressed during surgery. The median hospital stay was 3 ± 15.8 days. Three patients (4.6%) experienced major postoperative complications comprising 2 anastomotic leaks and 1 small bowel obstruction. The mean follow-up time was 26.2 ± 19.7 months, with 96.2% of patients reporting resolution of symptoms. There were no mortalities. Conclusions: Acid reflux is representing 43.7% of the indications for conversion from OAGB to RYGB. The symptom resolution rate holds significance, standing at a remarkable 96.8%. Despite surgical technique advancements, the complication rate after conversions remains significant at 4.6%, with no mortality reported. OAGB patients should be informed about these risks prior to undergoing conversions from OAGB to RYGB. [ABSTRACT FROM AUTHOR]

Aims: Roux‐en‐Y gastric bypass (RYGB) surgery alters postprandial glucose profiles, causing post‐bariatric hypoglycaemia (PBH) in some individuals. Due to the liver's central role in glucose homeostasis, hepatic glucose handling might differ in RYGB‐operated patients with PBH compared to non‐operated healthy controls (HC). Materials and Methods: We enrolled RYGB‐operated adults with PBH and HCs (n = 10 each). Participants ingested 60 g of [6,6′‐2H2]‐glucose (d‐glucose) after an overnight fast. Deuterium metabolic imaging (DMI) with interleaved 13C magnetic resonance spectroscopy was performed before and until 150 min post‐d‐glucose intake, with frequent blood sampling to quantify glucose enrichment and gluco‐regulatory hormones until 180 min. Glucose fluxes were assessed by mathematical modelling. Outcome trajectories were described using generalized additive models. Results: In RYGB subjects, the hepatic d‐glucose signal increased early, followed by a decrease, whereas HCs exhibited a gradual increase and consecutive stabilization. Postprandial hepatic glycogen accumulation and the suppression of endogenous glucose production were lower in RYGB patients than in HCs, despite higher insulin exposure, indicating lower hepatic insulin sensitivity. The systemic rate of ingested d‐glucose was faster in RYGB, leading to a higher, earlier plasma glucose peak and increased insulin secretion. Postprandial glucose disposal increased in RYGB patients, without between‐group differences in peripheral insulin sensitivity. Conclusions: Exploiting DMI with stable isotope flux analysis, we observed distinct postprandial hepatic glucose trajectories and parameters of glucose–insulin homeostasis in RYGB patients with PBH versus HCs. Despite altered postprandial glucose kinetics and higher insulin exposure, there was no evidence of impaired hepatic glucose uptake or output predisposing to PBH in RYGB patients. [ABSTRACT FROM AUTHOR]

Bariatric surgery complications carry a high rate of morbidity and mortality. This review highlights the pearls and pitfalls of bariatric surgery complications, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Bariatric surgeries include restrictive procedures (e.g., adjustable gastric banding, endoscopic gastric balloon insertion, and sleeve gastrectomy) and mixed restrictive and malabsorptive procedures (e.g., roux-en-y gastric bypass and duodenal switch-biliopancreatic diversion). Several complications may occur, which may be associated with severe morbidity and mortality. These complications include anastomotic/staple line leaks, small bowel obstruction and internal hernia, marginal ulceration, biliary disease, and device-specific issues. History concerning the type of surgery, when and where it was performed, prior complications, changes in weight, and systemic symptoms is essential. Many signs and symptoms are subtle, but fever, tachycardia, and persistent vomiting are concerning for a severe complication. If there is concern for a complication, emergent consultation with the bariatric surgeon is recommended (preferably the patient's surgeon). Imaging studies can assist in the evaluation, including computed tomography with oral and intravenous contrast. Resuscitation in the ED and early intervention by a bariatric surgeon provide the best opportunity to reduce morbidity and mortality for patients with intra-abdominal pathology. Understanding bariatric surgery complications can assist emergency clinicians in diagnosing and managing this potentially deadly disease. [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]

Background: This study investigates multiple rapid swallows during high-resolution esophageal manometry (HREM) as an indicator of esophageal dysmotility following bariatric surgery. Gastrointestinal complications, including esophageal dysfunction, are common after bariatric surgery, and predictive markers are lacking. Methods: Retrospective analysis of adult patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2013 and 2023 and were subsequently evaluated by HREM. Contractile reserve (CR) and breakthrough contractions were assessed during MRS and HREM studies assessed by the Chicago Classification version 4.0. Results: Breakthrough contractions were found in 52.2% of patients undergoing HREM during multiple rapid swallows (MRS), including 70% of patients classified as normal manometry. Presence of breakthrough contractions correlated with greater DCI (1039 vs. 446 mmhg-s-cm, p = 0.05), and was more common after SG compared to RYGB (58.3% vs. 41.7%, p = 0.089) and in proton pump inhibitor users (100% vs. 72.7%, p = 0.093). Contractile reserve was observed in 56.5% of patients, similar to non-bariatric cohorts. Conclusions: Breakthrough contractions are frequent in post-bariatric patients, even with normal manometry, suggesting early esophageal dysfunction. Sleeve gastrectomy patients showed a higher trend of these contractions, potentially due to increased intragastric pressure. Further studies are needed to understand long-term implications. [ABSTRACT FROM AUTHOR]

Background: RYGB consists of the Roux limb (RL), the biliopancreatic limb (BPL), and the common channel (CC). There is no consensus on the optimal limb lengths. Methods: Using a mouse model of RYGB, 30 diet-induced obese mice were divided into two groups with varying BPL and CC lengths: a standard BPL with a long CC (RYGB S) and a long BPL with a short CC (RYGB L). Additionally, 9 age-matched, lean control mice (LC) were also included in this study. Results: RYGB S had limb lengths of RL = 17%, BPL = 24%, and CC = 59%. RYGB L had limb lengths of RL = 17%, BPL = 32%, and CC = 51%. RYGB S and RYGB L had 67% and 40% survival, respectively. Mortality in RYGB L included more instances where the cause of death was not apparent. RYGB L demonstrated greater weight loss, lower energy expenditure, and lower heart mass as compared to RYGB S. Both RYGB groups had lower epidydimal fat mass, spleen mass, and bone mineral density compared to LC. RYGB L had a lower heart mass than RYGB S and LC. While the relative abundance of Eubacterium was lower in RYGB L than in RYGB S, no other gut microbiota differences were observed. Conclusions: A longer BPL with a shorter CC induces greater weight loss but may lead to adverse effects, including lower heart mass, reduced bone density, and deaths with unclear causes. [ABSTRACT FROM AUTHOR]

Background: There is a lack of up-to-date research addressing the causes of death and predictors of long-term mortality after bariatric surgery. Methods: This was a single-centre retrospective study. Trust records were used to identify deceased patients and their medical history. The demographic data, comorbidities, cause of death, and time since surgery were retrieved and tabulated. Data was recoded to allow for use in IBM SPSS. Results: There were 39 deaths amongst 891 patients who underwent bariatric surgery between 15th June 2010 to 18th September 2022. The main cause of death was pneumonia and respiratory causes with 15.4% of the cohort. A history of asthma/COPD had an association with the cause of death (p = 0.021). A history of hypertension, ischaemic heart disease (IHD), and smoking were all associated with a higher age at death, whilst a history of IHD was associated with a higher number of days from operation to death. Age at operation and number of comorbidities both correlated with age at death, and multiple linear regression of age at death with age at operation and number of comorbidities as predictors was significant (p < 0.001). A Cox regression found age at operation to have a significant effect on survival, with a hazard ratio of 1.063 (95% CI:1.027 to 1.100, p < 0.001). Conclusion: Pneumonia and respiratory causes are the largest causes of long-term mortality after bariatric surgery. The only factor found to have a detrimental effect on all-cause mortality was age at operation which reduced survival. Hypertension, IHD, and smoking are indirect factors that are associated with mortality. [ABSTRACT FROM AUTHOR]

Purpose: After Roux-en-Y gastric bypass (RYGB), few patients develop severe complications, which ultimately may require reversal of RYGB. We aimed to examine the effect of reversal of RYGB on symptoms and well-being. Materials and Methods: Via contact to medical and surgical departments treating patients with RYGB, we identified 18 patients, who had undergone reversal, 2009–2019. We conducted a Danish, nationwide questionnaire survey concerning symptoms before and after reversal of the RYGB including the patients' own perceptions of their well-being. Results: Fourteen patients responded to the questionnaire (86% female; median age at RYGB, 36.2 years [IQR, 30.9–38.6 years]). The median time from RYGB to reversal was 5.8 years (IQR, 5.1–7.5 years). After RYGB, 13 patients (93%) reported abdominal pain, while 12 patients still had abdominal pain after reversal. Six out of 11 patients (45%) reported complete remission of dumping/post-bariatric hypoglycemia (PBH) after reversal. Malabsorption disappeared in 10 out of 11 patients (90%). Reversal had minor effect on neuropathy. The median weight loss from RYGB was 61 kg (IQR, 56–75 kg), while the median weight regain after reversal was 30 kg (IQR, 13–46 kg). Regarding the well-being, 72 of the patients felt better or much better after reversal. Conclusion: In total, 72% of the patients felt better or much better after reversal of RYGB, though some still had RYGB-related symptoms. The reversal relieved dumping/PBH and malabsorption, but not abdominal pain and neuropathy. Finally, half of the weight loss was regained after reversal. Reversal of RYGB may be an option in highly selected cases. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) is the second most common metabolic and bariatric surgery (MBS) globally. The impact of pouch size on weight loss outcomes and complications remains unclear. This study aims to compare the weight loss outcomes and complications in long pouch versus short pouch RYGB in patients with severe obesity. This retrospective study, conducted in 2021 in two academic tertiary Hospitals, included patients aged 18–65 with severe obesity who underwent RYGB with two different methods. Demographic data, past medical history, and surgical details were assessed. The study outcome was postoperative metrics at 12 months including weight loss outcomes and complications like marginal ulceration, and leaks. A total of 219 patients, who were included in this study, were divided into two groups: 107 with long gastric pouches and 112 with short gastric pouches. The average age was 41.33 ± 10.26 and 42.45 ± 11.70 in long and short gastric pouches, respectively. Patients with long gastric pouches had a mean weight of 113.29 ± 16.52 kg and mean Body Mass Index (BMI) of 42.97 ± 4.15 kg/m2, and patients with short gastric pouches had a mean weight of 118.39 ± 12.80 kg and mean BMI of 45.21 ± 5.10 kg/m2. At 12 months after surgery, substantial weight loss was noted in all participants (37.8 ± 10.7 kg in patients with long gastric pouch; 48.1 ± 11.3 kg in patients with short gastric pouch; P = 0.033). Delta BMI (P = 0.072), and TWL% (P = 0.061), were more pronounced in patients with short pouches, however the difference was not significant. Remission of underlying diseases and endoscopic findings were comparable for short and long gastric pouch groups. Both long and short-pouch gastric bypass surgeries are effective and safe for weight loss and remission of obesity-associated medical problems in patients with severe obesity and exhibited similar rates for remission of underlying diseases and endoscopic findings. More studies are needed to individualize surgical approaches based on patient characteristics. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Key Results Conclusions Few data are available on functional lumen imaging probe (FLIP) findings specifically in obese patients. We aimed to evaluate FLIP metrics in obese patients who had not undergone bariatric surgery and in those who had sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB). We also sought correlations of FLIP abnormalities with esophageal symptoms and HRM findings.We identified obese patients who had FLIP performed during workups either for a first bariatric operation (surgery‐naïve patients), or for surgical revision of SG and RYGB operations that resulted in inadequate weight loss. We recorded esophageal symptoms, HRM data, and FLIP metrics.We identified 228 eligible patients (87 surgery‐naïve, 90 SG, 51 RYGB). Dysphagia and chest pain were frequent symptoms in all groups. Median EGJ diameter and EGJ‐DI were similar in surgery‐naïve and postsurgical patients, but subgroup analysis of symptomatic patients with no HRM diagnosis revealed reduced EGJ opening in 12%. Abnormal FLIP response patterns were common (69% surgery‐naïve, 74% SG, 65% RYGB) with higher ACR rates in SG (46.7% vs. 29.9%, p = 0.026) and RYGB (41.2% vs. 29.9%, p = 0.189) and lower SRCR rates in SG (11.1% vs. 24.1%, p = 0.021) and RYGB (5.9% vs. 24.1%, p = 0.006) compared to surgically naïve patients. There were no significant associations between FLIP contractile response patterns and symptoms or HRM diagnoses.Dysphagia and chest pain are common in obese patients, and most obese patients (with or without bariatric surgery) have FLIP contractile response abnormalities that do not correlate with HRM findings. FLIP findings appear to be especially valuable in obese patients who have esophageal symptoms with no HRM diagnosis. [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]

Background: Weight regain after Roux-en-Y gastric bypass (RYGB) can be seen in approximately 20% of patients. Surgical management options include revision of RYGB and conversion to duodenal switch (DS). Using recently included revisional surgery variables in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we compared the safety and efficacy of RYGB revision versus conversion to DS. Methods: An analysis of the 2020 MBSAQIP Participant Use Data File (PUF) revealed 1421 patients who underwent revision of RYGB (n = 1255) or conversion from RYGB to DS (n = 166) for inadequate weight loss or weight regain. Patient characteristics, preoperative body mass index (BMI), operating room (OR) time, and 30-day complications were compared between groups. Results: When compared with the revision RYGB group, the DS group had higher mean BMI (47.5 vs 42.7, p < 0.001) and longer operative time (209.1 vs 133.4 min, p < 0.001). DS had higher rates of any complication compared to revision RYGB (22.3 vs 5.58%, p < 0.001). DS had higher 30-day readmission rates (16.3 vs 5.50%, p < 0.001), reoperation within 30 days (9.04 vs 2.87%, p < 0.001), venous thromboembolism (VTE) (3.01 vs 0.08%, p < 0.001), intensive care unit (ICU) admission (8.43 vs 0.72%, p < 0.001), anastomotic leak (7.83 vs 0.40%, p < 0.001), surgical site occurrence (SSO) (11.5 vs 2.71%, p < 0.001), and death (0.60 vs 0%, p < 0.001). Conclusion: This short-term data suggests that conversion of RYGB to DS is associated with higher rates of postoperative complications when compared with revision of RYGB. Given the complexity of the procedure, it is best performed by experienced surgeons with careful consideration given to appropriate patient selection and only after extensive patient counseling on associated risks and complications. [ABSTRACT FROM AUTHOR]

Background: Preoperative patient frailty (i.e., aging-related functional decline across multiple physiological systems) has been linked to greater perioperative complications following metabolic bariatric surgery (MBS). This study evaluated whether preoperative patient frailty predicts 1-year suboptimal weight loss response after primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Methods: The Bariatric Frailty Score (BFS), an adapted version of the Canadian Study of Health and Aging-Frailty Index based on 10 variables from MBSAQIP, assessed degree of frailty based on number of deficits (i.e., 0–10). Suboptimal response to MBS was defined as < 20% and < 30% percentage total weight loss (%TWL) at 1 year following SG and RYGB, respectively. Multiple linear and logistic regression models evaluated associations of preoperative BFS score with %TWL and %TWL response thresholds, respectively. Results: Patients (n = 1574; 78.9% female, 28.3% non-white, mean age 45 ± 12 year; 67% SG) had a mean BFS of 1.6 ± 1.3 (range = 0–7). Overall, higher BFS related to lower %TWL after SG and RYGB (ß = − 0.12 and ß = − 0.17, respectively, p = 0.001). Compared to patients with 0–1 deficits (BFS score ≤ 1; n = 785, 49.9%), those with multiple deficits (BFS score ≥ 2; n = 789, 50.1%) had higher odds of suboptimal weight loss response after SG (OR 1.88, 95% CI 1.40–2.52, p < 0.001) and RYGB (OR 2.18, 95% CI 1.43–3.32, p < 0.001). Conclusion: Having multiple preoperative frailty deficits is associated with higher odds of suboptimal weight loss response after MBS. These findings point to the need for increased frailty screening and appropriate adjunctive interventions (i.e., exercise, nutrition, and cognitive), as these interventions may improve frailty status and MBS outcomes. [ABSTRACT FROM AUTHOR]

Background: There has been a rising trend of outpatient bariatric surgery, particularly accelerated by the COVID-19 pandemic. The aim of this study was to evaluate the safety and outcomes of same-day discharge laparoscopic Roux-en-Y gastric bypass (LRYGB) using the MBSAQIP database. Methods: In this retrospective study, the MBSAQIP was queried for patients undergoing non-revisional LRYGB between 2020 and 2021. Two cohorts were established: same-day discharge (SDD; length of stay = 0 days) and next-day discharge (POD1; length of stay = 1 day), with the latter serving as a control group. Univariate analysis and multivariate logistic regression were employed to compare outcomes between cohorts. Results: A total of 48,408 patients underwent LRYGB, with 1,918 (4.0%) SDD and 46,490 (96.0%) POD1. The two cohorts were similar in mean age (SDD 44.2 ± 11.3 years vs POD1 44.0 ± 11.3 years; p = 0.61) and female sex (SDD 83.8% vs POD1 83.1%; p = 0.43). However, the POD1 cohort had a higher preoperative body mass index (45.4 ± 7.3 vs 44.9 ± 7.3 kg/m2; p < 0.01). Preoperative anticoagulation and obstructive sleep apnea were more prevalent in the POD1 group. There was no difference in overall 30-day overall complication rates (SDD 2.0% vs POD1 2.3%; p = 0.51), reintervention, reoperations, mortality, and emergency department visits between the two cohorts. Readmissions were lower in the SDD cohort (2.9% vs 4.0%; p = 0.02), whereas the need for outpatient intravenous hydration was higher in the SDD cohort (6.7% vs 3.6%; p < 0.01). This finding remained significant even after adjustment for confounders. Conclusion: Same-day LRYGB is safe and feasible, with comparable complication rates to next-day discharge. Notably, SDD is associated with lower readmission rate and higher need for outpatient intravenous hydration, possibly reflecting rigorous bariatric protocols and thorough patient follow-up. Further investigations are warranted to elucidate the selection criteria and optimize postoperative care for outpatient LRYGB. [ABSTRACT FROM AUTHOR]

Summary: Background: 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. Methods: 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. Results: 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. Conclusions: 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]

Summary: Metabolic and Bariatric Surgery (MBS) is effective in improving metabolic outcomes and reducing weight in patients with obesity and diabetes, with less explored benefits in type 1 diabetes (T1D). This study aimed to evaluate the impact of MBS on weight loss and insulin requirements in T1D patients compared to insulin‐treated type 2 diabetes (T2D) patients over a 5‐year period. This retrospective analysis included patients who underwent primary sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB) with a confirmed preoperative diagnosis of either T1D or insulin‐treated T2D. Primary endpoints focusing on weight loss and secondary outcomes assessing changes in insulin dosage and glycemic control. After 5 years, weight loss was similar across groups, with total weight loss at 14.2% for T1D and 17.6% for insulin‐treated T2D in SG, and 22.6% for T1D vs. 26.8% for insulin‐treated T2D in RYGB. Additionally, there was a significant reduction in median daily insulin doses from 140.5 units at baseline to 77.5 units at 1 year postoperatively, sustained at 90 units at 5 years. The differential impact of MBS procedure was also highlighted, where RYGB patients showed a more pronounced and enduring decrease in insulin requirements compared to SG. [ABSTRACT FROM AUTHOR]

Douglas abscesses (DA) involving the ovaries and/or fallopian tubes and tubo-ovarian abscesses (TOA) constitute a very rare finding in virginal females. Underlying conditions are suspected to play a role in their development; often however, the exact pathomechanism remains hypothetical or unknown. We report the case of a 19-year-old virginal female who was referred to our outpatient clinic for further clarification of a 6-month ongoing secondary amenorrhea. In the course of the investigations, a large Douglas abscess with distinctive bilateral salpingitis was diagnosed as an incidental finding in a basically oligosymptomatic patient. Laparoscopic abscess drainage was performed and appropriate antibiotic therapy administered. Intraoperatively collected specimens revealed Escherichia coli to be the responsible pathogen and detected foreign body giant cell reaction to intestinal contents on histopathological workup. Retrospectively, a small bowel perforation at the level of the jejunojejunostomy after Roux-en-Y gastric bypass with spillage of intestinal contents and positive cultures for Escherichia coli, 6 months prior to her referral, was identified as the triggering event. This case, however unique its pathomechanism may be, demonstrates that a history of intestinal leakage in the context of bowel surgery should be considered a relevant risk factor for the development of DA and TOA in virginal females, even if the primary cause lies several months in the past. It is under these circumstances that the clinical presentation can be atypical and misleading, making it all the more difficult to diagnose. Nonetheless, considering the possibility of this rare condition in light of medical history is crucial. [ABSTRACT FROM AUTHOR]

The long-term cardiovascular benefits of bariatric surgery remain unclear. We aimed to analyze the association between bariatric surgery and cardiovascular disease outcomes. The Maryland Health Services Cost Review Commission database (2015-2022) was queried for patients aged 15 to 84 y with obesity. Bariatric surgery patients were matched with nonsurgical patients using propensity score matching. Primary outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. A subgroup analysis of outcomes based on age, sex, diabetes, and smoking status was performed. A total of 222,700 patients met the inclusion criteria. 104,855 (47.09%) bariatric and 117,845 (52.90%) nonsurgical patients were analyzed. Bariatric surgery was associated with reduced risk of all-cause mortality 12.1 versus 15.7 per 1000 person-years (hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.73-0.79, P < 0.001), HF (HR = 0.63, 95% CI = 0.69-0.67, P < 0.001), MI (HR = 0.69, 95% CI = 0.63-0.74, P < 0.001), and stroke (HR = 0.75, 95% CI = 0.69-0.80, P < 0.001). The association between bariatric surgery in the obese population and the improvement in cardiovascular outcomes was significantly pronounced in the pre-existing diabetes mellitus (DM) group compared to the non-DM group in terms of all-cause mortality, HF, and MI (adjusted HR = 0.59, 0.62, 0.59 respectively, P < 0.05). Bariatric surgery was also associated with a statistically significant reduction in all-cause mortality, MI, and stroke in smokers compared to nonsmokers (adjusted HR = 0.61, 0.59, 0.59 respectively, P < 0.05). Our study demonstrates a statistically significant association between bariatric surgery and improvement in long-term cardiovascular outcomes and reduction in all-cause mortality in the obese population following bariatric surgery. [ABSTRACT FROM AUTHOR]

Introduction: The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. Methods: A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. Results: There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), P value.034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), P value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7–4.1, P <.001). Conclusion: Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB. [ABSTRACT FROM AUTHOR]

Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most bariatric procedures in Asia. However, a comparison of long-term outcomes is still limited. To compare the degree of long-term weight loss, remission of comorbidities and complication rates after LRYGB and LSG procedures. A retrospective analysis was conducted for all patients who underwent LSG or LRYGB between May 2005 and May 2018 at a single institute with at least 1–5 years of follow up. Demographic data were collected. Of the total 342 patients, 159 underwent primary LSG and 183 patients underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than the LRYGB group (54.7 ± 12.6 kg/m2 vs 48.2 ± 8.2 kg/m2, P = 0.001). Comorbidities between LSG and LRYGB groups were similar. Mean percentage of total weight loss (%TWL) at 5 years after was 23.6 ± 1.7 % in the LSG group vs. 29.9 ± 1.3 % in the LRYGB group (P = 0.005) and LRYGB resulted in greater weight loss than LSG at all time points. The remission of comorbidities were similar in both groups, except that dyslipidemia was significantly better in the LRYGB group. Overall complications were 35.2 % in the LSG group vs. 20.8 % in the LRYGB group (P = 0.003). Our center revealed that LRYGB had better results than LSG in terms of percentage total weight loss at all time points. In the long term, LSG showed a higher overall complication rate compared to LRYGB. [ABSTRACT FROM AUTHOR]

Wingless-type inducible signaling pathway protein-1 (WISP1) is a newly recognized adipokine, associated with obesity and type 2 diabetes (T2DM). This study aimed to investigate the effect of metabolic and bariatric surgery (MBS) on WISP1 circulating (serum) levels and tissue expression using rat models. We initially investigated whether WISP1 circulating levels were altered between the T2DM and normal rats. After confirmation, Sprague–Dawley (SD) rats were obtained and randomly divided as follows: Roux-en-Y gastric bypass (RYGB) group (n = 10), sleeve gastrectomy (SG) group (n = 10), SHAM group (n = 10), and normal control (NC) group (n = 10). Rats were followed for 8 weeks postoperatively. Preoperative and postoperative WISP1 circulating (serum) levels, glucose tolerance test (OGTT), insulin tolerance test (ITT), postoperative WISP1 expression (visceral adipose tissue, VAT; and skeletal muscle, SM), body weight, food intake, and fasting blood glucose levels were recorded. MBS significantly induced glucose control and weight loss. At postoperative week 8, WISP1 serum levels decreased in the MBS groups (P < 0.05); furthermore, WISP1 expression in VAT and SM significantly decreased in the RYGB and SG groups than SHAM (P < 0.05, and P < 0.05, respectively). Whereas the difference in the expression level between SG and RYGB did not amount to statistical significance (P > 0.05). MBS significantly decreased WISP1 serum levels, tissue expression in the VAT, and SM. As WISP1 is a regulator of low-grade inflammation associated with obesity and T2DM, further studies are needed to explore its relevance in MBS. [ABSTRACT FROM AUTHOR]

Roux-en-Y gastric bypass (RYGB) is the preferred surgical option for patients with proven gastroesophageal reflux disease and obesity grade ≥ II (BMI ≥ 35 kg/m2). Data on simultaneous treatment of larger hiatal hernias during RYGB are scarce. From 2012 until 2022, data from all consecutive patients undergoing gastric bypass procedures were collected and retrospectively analyzed. The characteristics and surgical outcomes of patients undergoing RYGB alone (RYGBa) versus RYGB with simultaneous treatment of a large hiatal hernia (RYGB-HH) were compared. Out of 573 patients who received RYGB, we identified 12 simultaneously treated for large hiatal hernia. The characteristics of RYGB-HH versus RYGBa patients were higher age (55 vs. 44 years; p = 0.004) and lower BMI (39.2 vs. 46.9 kg/m2; p = 0.001). Duration of surgery in the RYGB-HH group was longer (144 min vs. 98 min; p < 0.001), while complications > Clavien–Dindo II were similar compared to the RYGBa group (8.3 vs. 9.4%, p = 0.56). Length of stay did not differ among the groups (4 vs. 5.5 days, p = 0.051). At a median follow-up of 12 months, there was no clinical recurrence of hiatal hernia in the RYGB-HH group. Simultaneous treatment of large hiatal hernias during Roux-en-Y gastric bypass surgery prolongs operation time but seems feasible and safe in the hands of experienced surgeons. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis evaluated changes in circulating irisin levels after bariatric surgery. A systematic search was performed across Embase, Scopus, PubMed, and Web of Science for this study. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) V4 software. The overall effect size was depicted through a random-effects meta-analysis and the leave-one-out method. The meta-analysis, which included 13 studies with a total of 407 participants, showed a statistically non-significant reduction in circulating irisin levels following bariatric surgery (SMD: – 0.089, 95% CI – 0.281, 0.102, 95% PI: – 0.790, 0.611, p = 0.360; I2:70.56). Our research found no significant change in irisin levels after bariatric surgery. Moreover, these findings were not associated with the type of surgery or the duration of follow-up. [ABSTRACT FROM AUTHOR]

Background: Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed. Objectives: The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). Setting: Integrated multispecialty health system, United States. Methods: Patients aged ≥ 18 years seen between May 2017 and July 2019, provided informed consent, completed the Food Craving Inventory (FCI), and had ≥ 1 year of follow-up after undergoing primary SG or RYGB were included in the study. Secondary data captured included psychological and behavioral measures. Preoperative and postoperative (3, 6, 9, and 12 months) FCI scores of patients who underwent SG and RYGB were compared. Results: Some attrition occurred postoperatively (N = 187 at baseline, 141 at 3 months, 108 at 6 months, 89 at 9 months, and 84 at 12 months). No significant relationship between pre- or postoperative food cravings and surgery type was found except on the carbohydrate subscale. Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. Likewise, patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m). Conclusions: Results suggest that food cravings in the year after bariatric surgery are equivalent by surgery type and do not appear to be related to preoperative psychological factors or eating behaviors. Level of evidence: Level III: Evidence obtained from well-designed cohort.Highlights: Food cravings are significantly reduced after bariatric surgery, although they generally do not differ by surgery type. (With the exception of carb cravings, specifically, which were higher for those undergoing RYGB than SG). Patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m). Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. [ABSTRACT FROM AUTHOR]

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) are increasingly prevalent in patients undergoing bariatric surgery (BS). Understanding their impact on weight loss outcomes after surgery and highlighting the results of surgical techniques such as Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) in relation to the presence of MASH are essential for improving patient management and predicting long-term success. Methods: A systematic review and meta-analysis were conducted. We searched the PubMed database; inclusion criteria were BS patients with liver impairment data at surgery and weight loss data at follow-up of 6 months or longer. Meta-analyses were conducted using R's meta package, assessing heterogeneity with the I2 statistic and employing subgroup analyses where necessary. Results: Out of 1126 eligible studies, 22 were included in the final systematic review. For the MASLD vs. Normal Liver (NL) comparison, no significant difference in BMI change was found at 12 months, but subgroup analysis indicated a possible publication bias (published data vs data collected). In the MASH vs. non-MASH comparison, high heterogeneity was noted at 12 months, and further stratification by surgical technique revealed that SG patients with MASH experienced lower weight loss, approaching statistical significance. Conclusions: MASLD does not significantly affect short-term weight loss outcomes post-BS, but long-term results show variability. Standardized reporting practices and complete data dissemination are essential for future research to enhance meta-analysis reliability and generalizability. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the efficacy of one-anastomosis gastric bypass (OAGB) on gastroesophageal reflux disease (GERD) compared with Roux-en-Y gastric bypass (RYGB) in patients with obesity. Three databases (Medline, Cochrane Central, and Scopus) were searched for relevant articles published until August 12, 2024. A total of nine randomized controlled trials, including 643 patients, were selected. OAGB was statistically significantly associated with a higher risk of GERD than RYGB (OR = 3.14, 95% CI 1.23–8.03, p < 0.05). The odds for de novo GERD after OAGB are almost six times higher than after RYGB (OR = 5.65, 95% CI 1.53–20.82, p < 0.05). RYGB has a lower incidence of de novo GERD cases and is more effective than OAGB in reducing GERD. [ABSTRACT FROM AUTHOR]