Surgery For Obesity And Related Diseases[JOURNAL]
Sun
200 papers
Placental lesions and fetal growth in pregnancy after metabolic bariatric surgery- a matched cohort study.
Mor L, Haziza R, Friedman M … +3 more , Kedar Sade E, Levy T, Rottenstreich A
Surg Obes Relat Dis · 2026 May · PMID 42248746 · Publisher ↗
BACKGROUND: Metabolic bariatric surgery (MBS) improves long-term metabolic health but has been associated with altered fetal growth patterns. The placental mechanisms underlying these outcomes remain incompletely charact...
BACKGROUND: Metabolic bariatric surgery (MBS) improves long-term metabolic health but has been associated with altered fetal growth patterns. The placental mechanisms underlying these outcomes remain incompletely characterized. OBJECTIVES: To compare placental histopathology and perinatal outcomes in pregnancies following MBS versus matched controls. SETTING: University hospital. METHODS: This retrospective matched cohort study included 306 term, singleton deliveries, comprising 153 pregnancies following MBS and 153 controls matched for maternal age, prepregnancy body mass index (BMI) and gestational age at delivery. Maternal demographics, pregnancy characteristics, delivery and neonatal outcomes, and placental histopathology were analyzed. Placental lesions were classified according to the standardized Amsterdam criteria, including maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and inflammatory lesions. Multivariate logistic regression was performed to evaluate independent predictors of small for gestational age (SGA) neonates. RESULTS: Maternal characteristics including demographics, rates of hypertensive disorders, diabetes mellitus, use of assisted reproductive technology, and smoking rates were comparable between the groups. In the post-MBS group birthweight was lower (3076±513 vs. 3308±427 g, P < .001), with a significantly higher rate of SGA (26.7% vs. 9.1%, P < .001) compared to the control group. Placental examination demonstrated higher rates of villous lesions of maternal malperfusion (54.2% vs. 41.8%, P = .030), and a higher composite rate of maternal malperfusion lesions (62.0% vs. 48.3%, P = .016) in the post-MBS group. In multivariate analysis, MBS (adjusted odds ratio [aOR] 3.41, 95% confidence interval [CI] 1.18-9.83), smoking (aOR 3.68, 95% CI 1.60-8.48), and composite maternal malperfusion lesions (aOR 2.92, 95% CI 1.26-6.77) were independently associated with the delivery of a SGA infant. CONCLUSION: Pregnancies following MBS demonstrate increased placental maternal malperfusion lesions and a substantially higher risk of SGA neonates. These findings suggest that altered placental vascular development may contribute to fetal growth restriction in this population and highlight the importance of enhanced antenatal surveillance and placental-focused research in post-MBS pregnancies.
Comparison of staple line reinforcement with nonreinforcement in Roux-en-Y gastric bypass surgery: a meta-analysis.
Li X, Yuan L, Zhang J … +7 more , Hu H, Liao J, Wei K, Ma S, Liu Q, Chen G, Tian Y
Surg Obes Relat Dis · 2026 May · PMID 42243017 · Publisher ↗
OBJECTIVE: Laparoscopic Roux-en-Y gastric bypass (RYGB) is a commonly used surgical procedure for the treatment of morbid obesity. Although surgical techniques continue to advance, the incidence of postoperative complica...
OBJECTIVE: Laparoscopic Roux-en-Y gastric bypass (RYGB) is a commonly used surgical procedure for the treatment of morbid obesity. Although surgical techniques continue to advance, the incidence of postoperative complications remain challenging to surgeons. This study aimed to systematically evaluate the effectiveness of staple line reinforcement (reinforced) versus nonreinforcement (nonreinforced) on postoperative complications (bleeding, leakage, stricture) in RYGB, and provide evidence-based basis for clinical surgical decision-making. METHODS: Databases (PubMed, Embase, and Cochrane Library) were searched for clinical studies published between 2003 and 2025 comparing staple line reinforcement versus nonreinforcement in RYGB, including randomized controlled trials and cohort studies. Pooled risk ratios (RRs) or mean differences were calculated using fixed- or random-effects models based on heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane risk of bias tool for randomized trials. Sensitivity analyses excluded studies including open RYGB and were further stratified by stapler type and mesh material. RESULTS: A total of 10 studies was included, including 3 randomized controlled trials and 7 cohort studies, involving 3680 patients (1889 in the reinforced group and 1791 in the nonreinforced group). The risk of bleeding complications in the reinforced group was significantly lower than that in the nonreinforced group (RR = .23, 95% confidence interval [CI] [.09, .60], P = .002) with low heterogeneity (I = 0%, P = .89). There was no statistically significant difference in anastomotic leakage between the two groups (RR = .30, 95% CI [.04, 2.13], P = .23) with high heterogeneity (I = 73%, P = .002). Staple line reinforcement was associated with a significant reduction in the risk of postoperative stricture between the two groups (RR = .25, 95% CI [.07, .85], P = .03) with high heterogeneity (I = 60%, P = .03). Sensitivity and subgroup analyses indicated that the primary findings were not influenced by the surgical approach (open vs laparoscopic), stapler type, or mesh materials. CONCLUSION: Staple line reinforcement in RYGB was associated with reduction in the risk of postoperative bleeding and stricture. However, it did not demonstrate a clear effect on the risk of postoperative leakage.
The dissonance of "expectation-reality": a narrative study on preoperative identity expectations and postoperative identity reconstruction of patients after metabolic and bariatric surgery.
He W, Zhang Y, Fang F … +3 more , Huang Q, Zhang R, Feng B
Surg Obes Relat Dis · 2026 May · PMID 42243016 · Publisher ↗
BACKGROUND: More than 1 billion people globally live with obesity. Individuals who have undergone metabolic and bariatric surgery (MBS) face identity reconstruction challenges linked to poor dietary adherence and psychol...
BACKGROUND: More than 1 billion people globally live with obesity. Individuals who have undergone metabolic and bariatric surgery (MBS) face identity reconstruction challenges linked to poor dietary adherence and psychological distress. Few studies analyze the mechanism of dissonance between preoperative identity expectations and postoperative reality, leaving a psychosocial support gap for long-term recovery. OBJECTIVES: To explore the dynamic collision between preoperative identity expectations and postoperative reality and identify key turning points in identity reconstruction among patients who have undergone MBS, guided by Social Identity Theory and Narrative Identity Theory. SETTING: Metabolic and Bariatric Surgery Department, University Hospital (June 2023-June 2024). METHODS: Purposive sampling of 18 patients who have undergone MBS (1-2 years postsurgery). Interpretive narrative design with semi-structured interviews; data triangulation (diaries, social media, and clinical records). Analysis used Riessman's framework integrated with Social Identity and Narrative Identity Theories. RESULTS: Preoperative expectations covered 4 dimensions (body image, social role, self-identity, and health function). Postoperative conflicts occurred across these dimensions, leading to a 3-stage identity reconstruction process: Conflict Adaptation (0-6 mo), Cognitive Adjustment (6-12 mo), and Identity Reconstruction (12-24 mo). Key turning points included successful social experiences, athletic breakthroughs, and family support. CONCLUSIONS: This study provides a theoretically grounded model of MBS identity reconstruction, highlighting the role of social group dynamics and narrative storytelling in navigating expectation-reality dissonance. The findings provide preliminary insights that may inform future development of clinical psychological support and psychosocial adaptation interventions.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program's role in the evolution of quality in metabolic and bariatric surgery.
El Ghazal N, Clapp B, Marrero K … +4 more , Davis SS, Kermansaravi M, Robertson AG, Ghanem OM
Surg Obes Relat Dis · 2026 May · PMID 42236442 · Publisher ↗
The growing prevalence of obesity has driven the widespread adoption of metabolic and bariatric surgery, recognized as the most effective treatment for this population. To improve the quality of care, several countries h...
The growing prevalence of obesity has driven the widespread adoption of metabolic and bariatric surgery, recognized as the most effective treatment for this population. To improve the quality of care, several countries have established metabolic and bariatric surgery registries to track outcomes, guide performance benchmarks, and advocate for changes and healthcare improvements. In the United States, collaboration between the American College of Surgeons and the American Society for Metabolic and Bariatric Surgery led to the creation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which has been instrumental in advancing these goals. Ongoing participation in Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program has been associated with improved surgical outcomes and enhanced patient safety. Its accreditation standards ensure that participating centers uphold high-quality care and support continuous improvement. Moreover, the program has facilitated the development of standardized guidelines and risk-benefit calculators that are now integral to shared decision-making between patients and providers.
The value of enhanced recovery after surgery in bariatric care: a systematic review and trial sequential meta-analysis confirming reduced length of stay, costs, and nursing-sensitive complications.
Hu F, Yang Y, Sun Y … +5 more , Sun L, Wang X, Jia Z, Gao N, Liu N
Surg Obes Relat Dis · 2026 May · PMID 42236441 · Publisher ↗
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care, but their adoption in bariatric surgery has been cautious, partly due to concerns about the safety of early oral feeding fo...
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care, but their adoption in bariatric surgery has been cautious, partly due to concerns about the safety of early oral feeding following complex procedures like gastric bypass. A comprehensive procedure-inclusive synthesis of its impact on both clinical and economic outcomes is warranted. SETTING: Department of general surgery, the Chinese PLA general hospital first medical center. OBJECTIVES: This systematic review and meta-analysis aimed to evaluate the impact of ERAS protocols on patients undergoing various bariatric procedures, focusing on length of stay (LOS), costs, and complications. METHODS: We conducted a systematic review and trial sequential meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies comparing ERAS with conventional care in bariatric surgery. Primary outcomes were hospital LOS and direct hospital costs; secondary outcomes included postoperative complications such as vomiting. RESULTS: Ten studies (8 RCTs, 2 cohorts) were included. ERAS significantly reduced LOS by .95 days (weighted mean difference = -.95; 95% confidence interval [CI]: -1.40 to -.50; P < .01). The incidence of postoperative vomiting was lower in the ERAS group (odds ratio = .35; 95% CI: .17 to .71; P < .01). Trial sequential analysis indicated firm evidence for reduced LOS. CONCLUSIONS: ERAS protocols in bariatric surgery are safe and effective, associated with faster recovery, shorter hospital stays, cost savings, and reduced vomiting. This study supports ERAS as a standard of value-based care across multiple bariatric procedures.
The impact of visceral obesity on the outcomes after resection of colorectal cancer: a systematic review and meta-analysis.
Wang S, Ding Y, Lin W … +5 more , Ma T, Mei J, Lin L, Li Z, He W
Surg Obes Relat Dis · 2026 May · PMID 42236440 · Publisher ↗
Obesity is closely associated with the initiation and progression of colorectal cancer (CRC) and is widely recognized as a risk factor for unfavorable surgical outcomes. Nevertheless, the extent to which visceral obesity...
Obesity is closely associated with the initiation and progression of colorectal cancer (CRC) and is widely recognized as a risk factor for unfavorable surgical outcomes. Nevertheless, the extent to which visceral obesity specifically influences perioperative safety and long-term oncologic outcomes following CRC resection remains to be established. We performed a systematic review and meta-analysis by comprehensively searching PubMed, Web of Science, Embase, Scopus, and the Cochrane Library. Continuous, dichotomous, and survival-related variables were synthesized using weighted mean difference (MD) or standardized MD (SMD), odds ratios (ORs), and hazard ratios (HRs), respectively. A total of 23 studies comprising 6,500 patients were included. Relative to patients without visceral obesity, those with visceral obesity demonstrated significantly prolonged operative time, greater intraoperative blood loss, higher rates of conversion to open laparotomy, increased overall postoperative complication rates, higher incidences of incisional wound infection and anastomotic leakage, a reduced number of harvested lymph nodes, and extended postoperative hospital stay. In contrast, no statistically significant differences were identified in postoperative mortality, positive surgical margin rates, time to first flatus, urinary dysfunction, 5-year disease-free survival, or 5-year overall survival. Collectively, these findings indicate that visceral obesity substantially increases intraoperative technical difficulty and postoperative morbidity; however, it does not appear to compromise long-term oncologic outcomes following CRC resection.
Applications of artificial intelligence along the perioperative pathway in metabolic and bariatric surgery.
Brar K, Chattha I, Gobraeil S … +6 more , Mocanu V, Corcelles R, Kroh M, Shin T, Dang JT, Lee Y
Surg Obes Relat Dis · 2026 May · PMID 42230262 · Publisher ↗
BACKGROUND: The use of artificial intelligence (AI) has rapidly increased in metabolic and bariatric surgery (MBS) in recent years, necessitating a comprehensive review characterizing the landscape of AI across the perio...
BACKGROUND: The use of artificial intelligence (AI) has rapidly increased in metabolic and bariatric surgery (MBS) in recent years, necessitating a comprehensive review characterizing the landscape of AI across the perioperative pathway of MBS care. OBJECTIVES: In this scoping review, we report on the applications of AI in the preoperative, intraoperative, and postoperative phases of care in MBS. SETTING: Scoping review including articles published internationally. METHODS: We systematically searched MEDLINE, Embase, Web of Science, and the Cochrane Database from inception until November 2024 for studies evaluating AI in any area of MBS. Studies were screened and extracted in duplicate, and a narrative synthesis of included studies was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. RESULTS: We identified 58 studies for inclusion, with the majority of studies evaluating the applications of AI in the postoperative (35/58, 60.3%) phase, followed by the intraoperative (7/58, 12.1%) and preoperative (4/58, 6.9%) phases. A further 11/58 (18.9%) of studies evaluated large language models (LLMs) in MBS. Neural networks were the most frequently described algorithm (used in 26/47, 55.3% of studies), with LLM studies most frequently evaluating ChatGPT (10/11, 90.9%). Studies demonstrated significant promise in the ability of AI to accurately predict postoperative outcomes and support preoperative and intraoperative decision-making, and LLM studies showed the promise of AI in improving patient education and clinical decision support. However, the vast majority of studies were limited by minimal external validation and lack of direct prospective clinical evaluation. CONCLUSIONS: While AI shows significant promise in MBS, the existing literature is limited by minimal clinical evaluation and lack of external validation. Future prospective large-scale studies of AI across the perioperative pathway in MBS are required to demonstrate the utility of these algorithms in improving MBS care and patient outcomes.
A literature review on reoperative metabolic and bariatric surgery for chronic complications: American Society for Metabolic and Bariatric Surgery Clinical Issues Committee and Surgery Revision Task Force.
Wesley Vosburg R, Carter J, Khorgami Z … +5 more , Fam J, El Djouzi S, Groller KD, Joe Northup C, Papasavas P
Surg Obes Relat Dis · 2026 May · PMID 42230261 · Publisher ↗
BACKGROUND: Reoperations account for approximately 11% of annual metabolic and bariatric surgery cases in the United States. Indications vary and include weight-related and complication-related issues. The number of Amer...
BACKGROUND: Reoperations account for approximately 11% of annual metabolic and bariatric surgery cases in the United States. Indications vary and include weight-related and complication-related issues. The number of American Society for Metabolic and Bariatric Surgery (ASMBS)-endorsed procedures has grown in popularity since the original 2014 ASMBS publication on reoperative metabolic and bariatric surgery (rMBS). OBJECTIVES: This paper was created as one of a 2-part update to the 2014 ASMBS publication on rMBS. SETTING: A literature review was conducted by the American Society of Metabolic and Bariatric Surgery's Clinical Issues Committee. Available literature from 2014 to present was included. METHODS: A search was performed using Ovid MEDLINE and PubMed databases looking for studies related to surgical treatments for chronic complications after metabolic and bariatric surgery. Relevant studies were screened for inclusion by the authors. RESULTS: rMBS serves an important role in the care of chronic complications after all ASMBS-endorsed procedures. In many cases, data are limited in quality to retrospective case series. Prevention is essential to limiting chronic complications and their associated morbidity and mortality. Mesenteric defect closure in all anastomotic MBS procedures is of paramount importance. Once chronic complications occur, a step-wise multidisciplinary approach is recommended, beginning with medical therapy, followed by endoscopic interventions, and ultimately rMBS when indicated. CONCLUSIONS: Surgeons should treat each patient presenting for rMBS on an individualized basis. Patient management should follow a structured escalation of care that prioritizes nonoperative treatments before progressing to rMBS.
Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass for weight recurrence and functional complications: a single-center experience.
Frieder JS, Altolaguirre A, Cobos MS … +4 more , Weiss BP, Lo Menzo E, Szomstein S, Rosenthal RJ
Surg Obes Relat Dis · 2026 May · PMID 42225533 · Publisher ↗
BACKGROUND: Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Despite its effectiveness, SG may lead to weight regain, gastroesophageal reflux disease (GERD), or functional complicat...
BACKGROUND: Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. Despite its effectiveness, SG may lead to weight regain, gastroesophageal reflux disease (GERD), or functional complications such as strictures, prompting conversion to Roux-en-Y gastric bypass (RYGB). OBJECTIVES: To report the indications for conversion from SG to RYGB and analyse their postoperative outcomes, including complications and weight loss when stratified by indication. SETTING: Single academic, bariatric center in the United States. METHODS: We conducted a retrospective analysis of all SG-to-RYGB conversions between 2004 and 2022. Patients were divided between Group A (converted for GERD or stricture) and Group B (weight regain). We compared demographics, complications, length of stay, and weight-related outcomes, including a subgroup analysis of patients converted for GERD and strictures. RESULTS: A total of 134 patients were included. From these, 50.7% were converted for weight regain 38.8% for GERD, and 10.4% for strictures. Mean time to conversion was 57.7 months (40.5 months for Group A; 64.1 for Group B). Major complications occurred in 5.2% of cases, with 7.6% in Group A and 2.9% in group B. Stricture patients had a higher complication rate when compared to GERD (53.8% vs 9.4%). In Group B, mean body mass index decreased from 43.4 to 32.1 at 12 months (p < 0.01), with sustained percent excess body mass index loss above 48% at >48 months. CONCLUSIONS: Conversion of SG-to-RYGB is safe and effective to achieve durable weight loss. However, patients converted for strictures face significantly higher risks and require tailored perioperative strategies.
The impact of obesity onset and duration on outcomes after metabolic bariatric surgery: an international multicenter cohort study.
Poljo A, Hasani A, Dalla Torre S … +14 more , Kollmann L, Raab S, Pentsch A, Shamiyeh A, Reichl JJ, Peterli R, Dirnberger AS, Noeva D, Süsstrunk J, Gockel I, Billeter AT, Müller BP, Schneider R, Klasen JM
Surg Obes Relat Dis · 2026 May · PMID 42225532 · Publisher ↗
BACKGROUND: Obesity prevalence is rising globally and is associated with multiple comorbidities. While metabolic bariatric surgery (MBS) is effective for weight loss and comorbidity improvement, the influence of obesity...
BACKGROUND: Obesity prevalence is rising globally and is associated with multiple comorbidities. While metabolic bariatric surgery (MBS) is effective for weight loss and comorbidity improvement, the influence of obesity onset and duration on postoperative outcomes remains unclear. OBJECTIVES: To evaluate whether age at obesity onset and obesity duration affect weight loss, comorbidity improvement, and postoperative complications following MBS. SETTING: Three University Hospitals, DACH-region (Germany, Austria, Switzerland). METHODS: Data from 1855 adults undergoing primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2010 and 2023 were retrospectively analyzed. Obesity onset was categorized as childhood (<10 years), puberty (10-17 years), or adult (≥18 years). Postoperative outcomes were assessed using % total body weight loss (%TBWL) and the SF-Bari Score, incorporating weight loss, comorbidity remission, and complications, over 4 years. Multivariable linear and mixed-effects models adjusted for age, sex, procedure type, and obesity duration. RESULTS: Baseline body mass index was highest in childhood-onset obesity (49.1 ± 9.2 kg/m) versus adult-onset (46.6 ± 7.8 kg/m, P < .005). Peak %TBWL at 2 years was 31.1% (childhood), 30.4% (puberty), 29.3% (adult), converging by year 4 (29.0%, 27.8%, 26.6%; P = .042). SF-Bari Scores were consistently "Good" (104-110). Age at surgery and procedure type were the strongest predictors: each additional year of age at surgery reduced %TBWL by .21%, and SG led to 3.8% less %TBWL than RYGB (P < .001). Obesity duration was not independently associated with weight loss. CONCLUSIONS: Childhood-onset obesity is linked to higher baseline BMI and parental obesity but does not impair mid-term MBS outcomes. Age at surgery and procedure type are primary determinants of postoperative weight loss, supporting equitable surgical access across obesity-onset groups.
Comment on: Robotic primary Roux-en-Y gastric bypass is independently associated with increased 30-day mortality: a 2023 MBSAQIP analysis of 50,365 patients.
Pina L, Parker DM
Surg Obes Relat Dis · 2026 Jul · PMID 42215390 · Publisher ↗
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Psychiatric morbidity after bariatric surgery and its association with postoperative body mass index: a national analysis.
Liu Z, Li L, Liu R … +4 more , Benharash P, Tomiyama AJ, Rosenthal RJ, Chen Y
Surg Obes Relat Dis · 2026 May · PMID 42215389 · Publisher ↗
BACKGROUND: Metabolic and bariatric surgery (MBS) remains the most effective intervention for durable weight loss and improvement of obesity-related comorbidities. However, its association with psychiatric morbidity rema...
BACKGROUND: Metabolic and bariatric surgery (MBS) remains the most effective intervention for durable weight loss and improvement of obesity-related comorbidities. However, its association with psychiatric morbidity remains unclear. OBJECTIVES: To evaluate the association between prior MBS status and psychiatric morbidity at a national level and to identify any contributing factors. SETTING: National Inpatient Sample, the largest publicly available all-payer inpatient database in the United States. METHODS: A retrospective cohort analysis was conducted using data from 2016 to 2021. Adult encounters (≥18 years) with documented body masss index (BMI) were included and stratified by prior MBS status. Following entropy balancing to minimize baseline differences, multivariable models were used to evaluate the independent cross-sectional association between prior MBS status and psychiatric morbidity odds. RESULTS: Among 32,879,950 encounters, 831,285 (2.5%) involved patients with prior MBS. After entropy balancing and risk adjustment, prior MBS status was independently associated with increased odds of depression (adjusted odds ratio [AOR], 1.70; 95% confidence interval [CI], 1.68-1.72), bipolar disorder (AOR, 1.52; 95% CI, 1.48-1.56), anxiety (AOR, 1.49; 95% CI, 1.47-1.51), and eating disorders (AOR, 1.34; 95% CI, 1.20-1.51), but not with suicidal ideation and attempt (AOR, 1.00; 95% CI, .95-1.06; P = .99). Within the MBS cohort, lower postoperative BMI was progressively associated with higher odds of psychiatric morbidity (P < .001 for trend). CONCLUSIONS: Prior MBS status is associated with increased odds of psychiatric morbidity, particularly among patients with lower postoperative BMI. While causality cannot be inferred, these findings highlight the need for integrated mental health screening and longitudinal psychiatric support throughout the perioperative continuum.
Optimizing Roux-en-Y gastric bypass: results of the BPG-1 randomized trial on limb length configuration.
Acín Gándara D, Pereira Pérez F, Arroyo Martín JJ … +2 more , Medina García M, Mans Muntwyler E
Surg Obes Relat Dis · 2026 Apr · PMID 42209300 · Publisher ↗
BACKGROUND: The optimal limb lengths for Roux-en-Y gastric bypass (RYGB) to maximize weight loss and address obesity-related diseases remain debated. OBJECTIVE: To compare the effect of a longer versus shorter biliopancr...
BACKGROUND: The optimal limb lengths for Roux-en-Y gastric bypass (RYGB) to maximize weight loss and address obesity-related diseases remain debated. OBJECTIVE: To compare the effect of a longer versus shorter biliopancreatic limb (BPL) in RYGB on weight loss and remission of associated diseases. SETTING: Multicenter randomized controlled trial in three university hospitals in Spain. METHODS: Ninety-eight adults with a body mass index (BMI) of 35-50 kg/m were randomized to receive either a 150 cm BPL with a 70 cm alimentary limb or the reverse configuration. Primary endpoint was weight loss at 2 years. Secondary endpoints included remission of obesity-related diseases, postoperative morbidity, and nutrients' status. RESULTS: Mean age and BMI were 47 years (standard deviation [SD] 9) and 45 kg/m (SD 4), respectively. Baseline demographic and clinical characteristics were comparable between groups. Mean operative time was 136 min (SD 30). Minimum median follow-up was 2 years. At 24 months, excess weight loss was 89% versus 78% (P = .02) and total weight loss was 39% versus 33% (P = .0002), favoring the long BPL group. Complete remission of type 2 diabetes mellitus (T2D) at 12 months was higher with the long BPL group (90% vs. 64%, P = .045). This finding was time-limited, with no significant difference at 24 months. No other comorbidities reached statistical significance. CONCLUSIONS: A longer BPL in RYGB is associated with greater weight loss and higher T2D remission at 1 year, with favorable trends for other associated diseases, supporting individualized limb-length tailoring. Definitive conclusions regarding metabolic outcomes cannot be drawn without larger, adequately powered studies.
Comment on: "Laparoscopic metabolic and bariatric surgery in patients with high body mass index-a Nationwide registry-based cohort study".
Zucchini N, Oviedo RJ
Surg Obes Relat Dis · 2026 Jul · PMID 42191445 · Publisher ↗
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Rates of de novo alcohol use disorder and de novo high-risk alcohol use after bariatric surgery: a systematic review and meta-analysis.
Cheloff AZ, Young S, Kim L … +3 more , Wander P, Castaneda D, Popov V
Surg Obes Relat Dis · 2026 Apr · PMID 42191444 · Publisher ↗
BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are among the most performed bariatric surgeries. Increased alcohol use has been reported after metabolic and bariatric surgery although data is con...
BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are among the most performed bariatric surgeries. Increased alcohol use has been reported after metabolic and bariatric surgery although data is conflicting, and the incidence of alcohol use disorders (AUDs) by type of intervention is unknown. OBJECTIVE: To assess the rates of de novo AUD and de novo high-risk alcohol use after metabolic and bariatric surgery and assess differences among the common procedures. SETTING: University Hospital, USA METHODS: MEDLINE and Embase were searched through March 23, 2025 for studies reporting alcohol use after metabolic and bariatric surgery. Study bias was assessed using the Grading of Recommendations Assessment, Development, and Evaluation and Newcastle-Ottawa scales. The primary outcome was the pooled event rate for de novo AUD and de novo high-risk alcohol use after metabolic and bariatric surgery. Heterogeneity was considered substantial if I>50%, and this was investigated further by meta-regression and subgroup analyses. Secondary outcomes included rates of de novo AUD/high-risk alcohol use pre- and post-metabolic and bariatric surgery. RESULTS: Fifty-four studies including 934,824 patients were included. The incidence of de novo AUD/high-risk alcohol use after any metabolic and bariatric surgery was 2.49% (95% confidence interval [CI] 2.34-2.65, P = .001). The RYGB group had higher rates compared to those who underwent any other surgeries (1.48%, 95%CI 1.32-1.65, P = .01) and compared to those post-SG (.77%, 95% CI .60-.96, P < .001), but differences were not significant when the analyses were limited to studies with direct comparisons of procedure types. The odds of de novo AUD/high-risk alcohol use increased postsurgery in the RYGB cohort (odds ratio [OR] 1.81, 95% CI 1.06-3.08, P = .03) but not in the other surgery (OR .78, 95% CI .41-1.49 P = .45) or SG cohort (OR .67, 95% CI .14-3.08, P = .60). CONCLUSION: De novo AUD and high-risk alcohol use appear to increase after both RYGB and SG, with no clear difference between procedures. Interpretation is limited by heterogeneous outcomes and predominantly retrospective data.
Outcomes of conversion from sleeve gastrectomy to Roux-en-Y gastric bypass for the treatment of gastroesophageal reflux disease.
Cymbal M, Prado R, Sierra L … +9 more , Chatterjee A, Firkins SA, Patel R, Khurana A, Yang Q, McMichael J, Flora B, Staneff E, Simons-Linares R
Surg Obes Relat Dis · 2026 Apr · PMID 42191443 · Publisher ↗
BACKGROUND: Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure in the United States, but it is associated with an increased risk of de novo or worsened gastroesophageal reflux disease (GERD). Conv...
BACKGROUND: Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure in the United States, but it is associated with an increased risk of de novo or worsened gastroesophageal reflux disease (GERD). Conversion to Roux-en-Y gastric bypass (RYGB) is considered the gold standard for treating refractory GERD after SG, though objective outcomes remain under-reported. OBJECTIVES: To evaluate the efficacy of conversion from SG to RYGB for medically refractory GERD using objective measures of improvement. Secondary objectives included assessing whether weight loss, additional anatomic repairs, or application of updated American College of Gastroenterology (ACG) GERD diagnostic criteria impacted outcomes. SETTING: Academic tertiary care center (Cleveland Clinic Foundation, Cleveland, Ohio, United States). METHODS: A retrospective cohort study was conducted on patients who underwent SG followed by RYGB for refractory GERD from July 2004 to August 2024. GERD improvement was defined as decreased use of proton pump inhibitors (PPIs), endoscopic, or pH testing improvement. Logistic regression and chi-square analyses were used to assess predictors of improvement. RESULTS: Of 117 patients, 53 (45.3%) showed objective GERD improvement post-RYGB. Most improved via reduction in PPI omeprazole equivalence (88.7%), of which 35.8% discontinued PPIs completely. Neither total body weight loss (P = .257) nor concurrent anatomical repairs (P = .615) correlated with GERD improvement. Meeting new ACG GERD diagnostic criteria was significantly associated with improvement (63.6% vs 33.3%, P = .03). CONCLUSION: Conversion to RYGB results in objective GERD improvement in nearly half of patients undergoing conversion, independent of weight loss or anatomical repairs. ACG diagnostic criteria may help predict which patients benefit most. Prospective studies are needed to validate findings and refine surgical decision-making.
The truth is in the patient; all you have to do is ask.
Alhazmi A, le Roux CW
Surg Obes Relat Dis · 2026 Apr · PMID 42173771 · Publisher ↗
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From accreditation to outcomes: the evolution and future of quality improvement in bariatric surgery.
McDonough W, Clapp B
Surg Obes Relat Dis · 2026 Jul · PMID 42167993 · Publisher ↗
Bariatric surgery is the most effective intervention for severe obesity and its metabolic comorbidities. Over the last 2 decades, systematic quality improvement (QI) initiatives have transformed the field, leading to enh...
Bariatric surgery is the most effective intervention for severe obesity and its metabolic comorbidities. Over the last 2 decades, systematic quality improvement (QI) initiatives have transformed the field, leading to enhanced safety and improved outcomes. This review highlights five major QI initiatives-Enhanced Recovery After Surgery (ERAS), participation in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), fellowship training, Accredited Bariatric Centers, and the Focused Practice Designation in Metabolic and Bariatric Surgery. We examine the historical evolution, supporting data, and persistent challenges associated with each. Moving forward, the field must prioritize long-term outcomes and follow-up, procedural consistency and standardization, and equitable access. Expanding follow-up periods for the MBSAQIP, optimizing ERAS for high-risk groups, and further formalizing fellowship training are logical next steps.
Surgeon perspectives on same-day discharge after bariatric surgery: a statewide survey in Michigan.
Choo K, Howard R, Jackson HT … +6 more , Petersen S, Finks J, Carlin AM, Varban O, O'Neill S, Obeid N
Surg Obes Relat Dis · 2026 Apr · PMID 42167992 · Publisher ↗
BACKGROUND: Although the prevalence of same-day discharge (SDD) after bariatric surgery has more than doubled in recent years, the practice remains controversial. We conducted a survey of practicing bariatric surgeons ac...
BACKGROUND: Although the prevalence of same-day discharge (SDD) after bariatric surgery has more than doubled in recent years, the practice remains controversial. We conducted a survey of practicing bariatric surgeons across Michigan to evaluate surgeon perspectives toward SDD. OBJECTIVES: To characterize surgeon perceptions and barriers to SDD adoption in Michigan. SETTING: Academic and community bariatric surgery programs participating in the Michigan Bariatric Surgery Collaborative (MBSC), a statewide quality improvement collaborative. METHODS: Surgeon survey was distributed to all surgeons of MBSC. This survey included questions regarding current practice of SDD and potential concerns or barriers to implementation. The questions were multiple-choice items with optional free-text responses, with some allowing selection of more than one response option. RESULTS: The overall response rate to the survey was 100% (N = 76). Only 15 (20%) reported performing SDD. Concerns about "Overall risks" (39 [51%]) and "Fear of complications" (26 [34%]) were identified as the leading reasons for not performing. Key institutional barriers included "Safety concerns" (41 [54%]) and "Lack of outpatient resources" (22 [29%]). Perceived advantages were rarely endorsed, and no free-text responses supported SDD. The most frequently cited disadvantages were "Failure to rescue" (69 [91%]) and "Inability to monitor" (64 [84%]). CONCLUSIONS: SDD after bariatric surgery is not widely adopted in Michigan, primarily due to surgeon safety concerns and limited outpatient resources. These findings indicate that institutional readiness and postoperative support capacity remain key constraints to broader SDD adoption.
Early changes in cognitive function following bariatric surgery: evidence for rapid improvement or practice effects?
Burke E, Gunstad J, Bond D … +5 more , Carroll I, Crosby R, Mitchell JE, Heinberg LJ, Steffen K
Surg Obes Relat Dis · 2026 Apr · PMID 42161712 · Publisher ↗
BACKGROUND: Metabolic bariatric surgery (MBS) is associated with postoperative improvement in neuropsychological test performance and recent work raises the possibility that these gains may emerge within weeks of surgery...
BACKGROUND: Metabolic bariatric surgery (MBS) is associated with postoperative improvement in neuropsychological test performance and recent work raises the possibility that these gains may emerge within weeks of surgery. However, repeat testing across brief postoperative intervals introduces the possibility of measurement error that artificially increases test scores and distorts understanding of postoperative changes. OBJECTIVE: Examine cognitive function prior to and 1-month following bariatric surgery. SETTING: University Hospital. METHODS: A total of 111 MBS participants completed the NIH Toolbox for the Assessment of Neurological and Behavioral Function test battery before and 1-month after MBS as part of a larger project. RESULTS: Repeated measures analysis of covariance revealed improved cognitive test scores following both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), though reliability change metrics could not rule out contribution from practice effects. Receiver operating characteristic analyses revealed that lower preoperative body mass index (BMI) was associated with greater likelihood of true cognitive improvement post-MBS on the Pattern Comparison subtest of the NIH Toolbox (area under the curve = .65, 95% confidence interval .53-.76). CONCLUSIONS: Though both RYGB and SG patients exhibited improved cognitive function 1-month postoperatively, the current results suggest these early gains should be interpreted cautiously as they may reflect more than just neurobiological factors. Preoperative BMI may predict cognitive trajectory post-MBS, though future research is needed to refine cognitive testing procedures with the goals of clarifying the timeline of neurological changes postoperatively and whether MBS may reduce risk of Alzheimer disease and other risk factors for cognitive decline.
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