BACKGROUND: Intragastric balloon (IGB) therapy is a minimally invasive intervention for weight management. However, maintenance after balloon removal and predictors of sustained weight loss at 1year remain uncertain. MET...BACKGROUND: Intragastric balloon (IGB) therapy is a minimally invasive intervention for weight management. However, maintenance after balloon removal and predictors of sustained weight loss at 1year remain uncertain. METHODS: This retrospective single-center study included patients who underwent fluid-filled IGB placement between January 2015 and December 2019 at Istishari Teaching Hospital, Amman, Jordan. Inclusion criteria were age ≥13 years and IGB insertion for weight control. Balloons were endoscopically placed and removed at 6 months per standard protocol. No concurrent weight loss interventions were permitted. Total weight loss percentage (TWL%) was calculated at balloon removal (6 months after balloon insertion), at 6 and 1year after balloon removal. Patients were stratified by pretreatment body mass index (BMI): Group 1 (25-29.9), Group 2 (30-34.9), Group 3 (35-39.9), and Group 4 (≥40 kg/m). Multivariate linear and logistic regression identified predictors of BMI and ≥10% TWL at 1year after balloon removal, respectively. RESULTS: A total of 478 patients (74.3% female; mean age 31.3 ± 8.8 years; mean pretreatment BMI 36.1 ± 8.1 kg/m) were included. Mean TWL% was 12.8% at removal, 7.5% at 6 months after removal, and 4.0% at 1year after removal (P < .0001). Higher pre-treatment BMI predicted greater TWL% at all time points (P < .001) but was also associated with higher BMI at 1year (β range: +4.45 to +20.92; P < .001). Age was modestly associated with higher BMI (β = +.07; P = .002). In logistic regression, age predicted ≥10% TWL at 1year (odds ratio [OR] 1.04; P = .040), while Groups 3-4 had lower odds (OR .29 and .24; P < .05). In contrast, sex (P = .051) and BMI Group 2 (P = .447) were not significant predictors of achieving ≥10% TWL at 1year. CONCLUSION: Pretreatment BMI and age independently influenced weight trajectories following IGB therapy. Patient selection based on lower BMI categories (25-35 kg/m) and integration with postremoval support programs may be key to optimizing 1-year outcomes.
Obesity is a global public health issue. This condition is linked to gastroesophageal reflux disease (GERD) and hiatal hernia (HH), both of which are exacerbated by increased intra-abdominal pressure. Roux-en-Y gastric b...Obesity is a global public health issue. This condition is linked to gastroesophageal reflux disease (GERD) and hiatal hernia (HH), both of which are exacerbated by increased intra-abdominal pressure. Roux-en-Y gastric bypass (RYGB) is one of the most widely performed techniques for treating obesity and is considered a versatile option suitable for most patients. The development of a symptomatic HH and pouch migration can lead to various symptoms and complications. PubMed, EMBASE, and Cochrane Central were searched for studies with late HH after RYGB. We pooled outcomes for symptom resolution. Secondary outcomes were recurrence rate and operation characteristics (mesh use, cruroplasty, gastropexy, reoperation, length of stay, and operative time). A meta-analysis could not be conducted due to significant heterogeneity in HH. HH following RYGB presents with GERD (39-93.6%), obstructive symptoms (29%-88%), and abdominal pain (28.6%-71%). Diagnostic methods include endoscopy, computed tomography scans, and upper gastrointestinal series. Surgical management varies, with primary cruroplasty being the most common approach, sometimes incorporating mesh or fundoplication. Postoperative symptom resolution rates range from 42.9% to 100%, with HH recurrence occurring in 5%-6.54% of cases. Follow-up durations varied, showing improvement in most patients, though some continued to experience reflux and dysphagia HH contributes to obstructive and reflux symptoms, with contrast-enhanced imaging offering the highest diagnostic accuracy. Bioabsorbable mesh may reduce recurrence, highlighting the need for long-term monitoring.
BACKGROUND: Obesity is strongly associated with cardiovascular disease and cardiac arrhythmias, particularly atrial fibrillation and flutter (AF/AFL). Metabolic and bariatric surgery (MBS) produces durable weight loss an...BACKGROUND: Obesity is strongly associated with cardiovascular disease and cardiac arrhythmias, particularly atrial fibrillation and flutter (AF/AFL). Metabolic and bariatric surgery (MBS) produces durable weight loss and improves cardiometabolic risk factors, but its association with arrhythmia in large real-world populations remains incompletely characterized. OBJECTIVES: To evaluate the association between MBS and the risk of atrial/ventricular arrhythmias and all-cause mortality in adults with severe obesity. SETTING: Multicenter electronic health record network (TriNetX Global Collaborative Network). METHODS: We conducted a retrospective cohort study of adults with severe obesity using the TriNetX Global Collaborative Network. Patients undergoing MBS were compared with nonsurgical controls without prior arrhythmias. One-to-one propensity score matching was performed based on demographic characteristics and established arrhythmia risk factors. Outcomes included incident AF/AFL, ventricular tachycardia, ventricular fibrillation, cardioversion, and all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: After propensity score matching, 38,953 patients were included in each cohort. AF/AFL occurred less frequently in the MBS cohort compared with non-surgical controls (2.1% vs 3.3%; HR .73, 95% CI .67-.79). Ventricular tachycardia (HR 1.02, 95% CI .83-1.25), ventricular fibrillation (HR 1.53, 95% CI .80-2.92), and cardioversion (HR .92, 95% CI .62-1.23) were not significantly different between groups. All-cause mortality was significantly lower among patients undergoing MBS compared with nonsurgical controls (.5% vs 2.8%; HR .24, 95% CI .20-.28). CONCLUSIONS: In this large real-world cohort, MBS was associated with a lower risk of incident AF/AFL and substantially reduced all-cause mortality compared with non-surgical management.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including semaglutide and tirzepatide, are increasingly prescribed for obesity and type 2 diabetes and have demonstrated substantial and rapid weight loss in large ra...Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including semaglutide and tirzepatide, are increasingly prescribed for obesity and type 2 diabetes and have demonstrated substantial and rapid weight loss in large randomized trials. At the same time, prehabilitation before major abdominal surgery has become an established perioperative strategy to improve postoperative outcomes. This review explores the potential role of GLP-1RAs as a pharmacological adjunct in multimodal surgical prehabilitation. We discuss the biological rationale for metabolic optimization, the relevance of sarcopenic obesity, potential implications for oncological surgery and neoadjuvant therapy, and emerging data from bariatric and metabolic surgery. We also highlight important perioperative safety considerations, particularly delayed gastric emptying and aspiration risk, and current anesthetic guidance. Although integration of GLP-1RAs into prehabilitation pathways is biologically plausible and clinically attractive, there is currently no direct evidence supporting their use in this setting. We propose that GLP-1RAs represent a promising and testable strategy for metabolic optimization in surgical patients. Prospective studies are required to evaluate feasibility, safety, and impact on clinically meaningful outcomes. This framework is hypothesis-generating and aims to inform future translational research at the interface of metabolic medicine and perioperative care.
BACKGROUND: Targeted metabolomic profiling uncovers metabolic adaptations after bariatric surgery, but data in Asian populations remain limited. OBJECTIVES: To investigate postoperative plasma metabolite changes and iden...BACKGROUND: Targeted metabolomic profiling uncovers metabolic adaptations after bariatric surgery, but data in Asian populations remain limited. OBJECTIVES: To investigate postoperative plasma metabolite changes and identify metabolic signatures associated with weight loss after sleeve gastrectomy (SG). SETTING: A tertiary university hospital in Korea. METHODS: We prospectively enrolled 49 Korean patients with severe obesity who underwent laparoscopic SG. Plasma samples were collected before and 6 months after SG. Targeted metabolomic profiling (liquid/gas chromatography-tandem mass spectrometry) quantified 101 metabolites-including amino acids, organic acids, fatty acids and nucleosides. Patients were categorized as optimal weight loss (OWL; total body weight loss [TBWL] ≥25%, n = 26) and suboptimal weight loss (SWL; TBWL< 25%, n = 23). Statistical comparisons and pathway enrichment analyses were performed. RESULTS: Seventy-eight metabolites exhibited significant postoperative changes (false discovery rate< .05). Citric acid significantly increased after SG (Δ = 1.14 ng/μL, P < .001), with a greater increase in OWL than SWL (Δ = 1.98 vs. .19 ng/μL, P = .017), and was positively correlated with TBWL (r = .40, P = .005). Five fatty acids decreased significantly after SG. Two monounsaturated fatty acids-myristoleic and palmitoleic-decreased more in OWL, correlating negatively with TBWL (r = -.33 and -.28, respectively). In contrast, long/very-long-chain saturated fatty acids-eicosanoic, docosanoic, and tetracosanoic-decreased more in SWL, correlating positively with TBWL (r = .32, .44, and .39, respectively). Pathway enrichment highlighted tricarboxylic acid cycle and fatty acid degradation as key altered pathways. CONCLUSION: SG induced distinct changes in plasma citric and fatty acid levels associated with weight-loss outcomes, suggesting mitochondrial adaptation and rebalanced fatty acid metabolic homeostasis during postoperative recovery.
BACKGROUND: Utilization of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for weight loss has substantially increased in recent years, yet it remains unclear how the characteristics of patients pursuing metabolic a...BACKGROUND: Utilization of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for weight loss has substantially increased in recent years, yet it remains unclear how the characteristics of patients pursuing metabolic and bariatric surgery (MBS) have evolved during this time. OBJECTIVES: This study compares patient characteristics and perioperative outcomes for primary and revisional MBS procedures from 2015 to 2023. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating centers in the United States. METHODS: The MBSAQIP database was queried to identify all sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and revision/conversion procedures (revision). Preoperative body mass index (BMI), American Society of Anesthesiologists (ASA) score, number of comorbidities, and perioperative outcomes were analyzed longitudinally. RESULTS: The number of procedures increased from 2015 to 2023 (SG: 91,553 vs 129,475; RYGB: 43,143 vs 60,312; revision: 23,138 vs 26,478). For primary MBS, average BMI decreased (SG: 45.3 [8.3] vs 44.9 [7.8], P < .001; RYGB: 46.6 [8.6] vs 45.9 [8.0], P < .001), while ASA scores did not change. Number of comorbidities decreased for SG (1.6 [1.4] vs 1.5 [1.4], P < .001) but remained the same for RYGB. For revisional procedures, average BMI (39.4 [9.7] vs 41.1 [8.5]; P < .001), ASA score (2.7 [.5] vs 2.8 [.5], P < .001), and number of comorbidities (2.3 [1.4] vs 2.6 [1.4], P < .001) increased. Perioperative outcomes improved for all procedures. CONCLUSIONS: Primary MBS is now being performed in patients with lower average BMI, while revisional cases are performed in patients with higher BMI and more comorbid conditions. Despite this, perioperative outcomes have improved, highlighting the safety of modern MBS in the modern GLP-1 era.
BACKGROUND: Evidence suggests metabolic health plays a significant role in long-term cognitive outcomes. Whether this association stems from weight loss operations or other factors, remains controversial. Although a link...BACKGROUND: Evidence suggests metabolic health plays a significant role in long-term cognitive outcomes. Whether this association stems from weight loss operations or other factors, remains controversial. Although a link between metabolic and bariatric surgery (MBS) and reduced likelihood of cognitive impairment has also been reported, a large-scale analysis of this association is lacking. OBJECTIVE: To evaluate the association of prior metabolic surgery and the odds of cognitive impairment. SETTING: Academic, university-affiliated; US. METHODS: All adult (≥18 years) hospitalizations with a diagnosis of obesity were identified in the 2016-2022 Nationwide Inpatient Sample. The association of MBS with odds of cognitive impairment and its subclasses was characterized after doubly robust risk adjustment using entropy balancing followed by multivariable regression models. RESULTS: Of 4,597,465 admissions with a diagnosis for obesity, 22.1% had a history of MBS. Following adequate risk-adjustment, prior MBS was associated with lower odds of Alzheimer's disease (AD) (adjusted odds ratio [AOR] .67, 95% confidence interval [CI] .59-.75) and vascular dementia (AOR .55, 95% CI .47-.64), but greater odds of Wernicke's Encephalopathy (AOR 5.03, 95% CI 3.76-6.72). These findings persisted across all age groups. Among the three classes of obesity, patients with a history of MBS with class III obesity had the lowest odds of dementia (AOR .66, 95% CI .60-.72). CONCLUSIONS: Prior MBS is associated with lower odds ratio of AD and vascular dementia, among those with obesity. These findings suggest that MBS may reduce the odds of cognitive impairment across various demographics.
Binte Mohd Kamil SH, Masuda Y, Lee PP
… +13 more, Jin LZ, Eng A, Lim E, Chan WH, Tan J, Tan S, Chang TH, Ho E, Kovalik JP, Goh O, Sim J, Lee PC, Lim CH
BACKGROUND: In patients with obesity and ventral hernias, there is growing interest in combining ventral hernia repair with metabolic and bariatric surgery (MBS) as a concurrent procedure. This reduces anesthetic exposur...BACKGROUND: In patients with obesity and ventral hernias, there is growing interest in combining ventral hernia repair with metabolic and bariatric surgery (MBS) as a concurrent procedure. This reduces anesthetic exposures and decreases costs associated with separate surgeries. OBJECTIVES: This study aims to evaluate the safety and efficacy of concurrent ventral hernia repair and MBS compared to ventral hernia repair alone. SETTING: University Hospital. METHODS: A single-center, retrospective study was conducted on 174 patients treated with either ventral hernia repair alone or concurrent ventral hernia repair with MBS from January 2016 to December 2023. There was no loss to follow-up. A propensity-score matched analysis was performed, and 6 characteristics were selected as covariates (age, gender, race, preoperative body mass index, hernia defect size, smoking history and diabetic status). Separate univariate analyses were conducted to determine if outcomes differed by surgical approach. RESULTS: Treated patients undergoing concurrent surgery were less likely to experience hernia recurrence (OR = .114, 95% CI .062-.21, P < .001) compared to those receiving hernia repair alone. They also had a lower likelihood of complications such as seromas and stitch granulomas (OR = .362, 95% CI .167-.783, P = .01). CONCLUSION: Concurrent ventral hernia repair with MBS is a safe and effective option for patients with obesity and ventral hernias. It demonstrates comparable rate of short-term perioperative complications and offers long-term advantages, including reduced rates of hernia recurrence.
BACKGROUND: Sleeve gastrectomy (SG) is the most performed bariatric procedure worldwide. However, large-scale data concerning SG performed as same-day discharge (SDD) surgery are scarce. OBJECTIVES: To compare 90-day mor...BACKGROUND: Sleeve gastrectomy (SG) is the most performed bariatric procedure worldwide. However, large-scale data concerning SG performed as same-day discharge (SDD) surgery are scarce. OBJECTIVES: To compare 90-day morbi-mortality between SDD and inpatient SG using a nationwide French database over a 9-year period. SETTING: Comprehensive data from the French National Health Data System including data over 599 surgical centers. METHODS: From January 2015 to December 2023, all patients aged 18-70 years who underwent SG for obesity (244,992 patients) were included and divided into two groups: SG as SDD (SDD group) and SG as inpatient surgery (control group). The primary outcome was a comparison of 90-day morbi-mortality between SDD and inpatient groups. The secondary outcomes included trends in SDD adoption, patient characteristics, and risk factors for complications. Multivariate logistic regression and propensity score matching was used to search for factors influencing completion of SG as SDD. RESULTS: Among 244,992 patients, 5046 (2.1%) underwent SDD. The SDD rate increased until 2021 (peak: 4.2%) and stabilized thereafter (3.3%). SDD patients were younger (37.3 vs. 39.9 years, P < .001); more often female (82.7% vs. 78.7%, P < .001); and had less hypertension, diabetes, and obstructive sleep apnea (P < .001). Concerning our primary objective, SDD was associated with lower morbi-mortality (7.5% vs. 8.3%, P = .033) in our total cohort study. After propensity score matching, no difference was found between SDD and inpatient group (odds ratio [OR] = .94, P = .324). Risk factors for morbi-mortality included diabetes (OR = 1.33, P < .001), renal insufficiency (OR = 4.90, P < .001), and anticoagulant therapy (OR = 1.45, P < .001). Older age, type 2 diabetes, hypertension, obstructive sleep apnea, and oral anticoagulation therapy were negatively associated with the completion of SDD, whereas the type of surgical center was positively associated with its completion. CONCLUSIONS: SDD for SG remains underutilized in France but is associated with lower morbi-mortality, likely due to stringent patient selection. Older age, type 2 diabetes, hypertension, obstructive sleep apnea, and oral anticoagulation therapy were independently associated with a lower probability of completing SDD.
BACKGROUND: Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective and sustainable treatment for obesity but concerns regarding its long-term outcomes persist. OBJECTIVE: Contribute to the long-term data...BACKGROUND: Biliopancreatic diversion with duodenal switch (BPD-DS) is an effective and sustainable treatment for obesity but concerns regarding its long-term outcomes persist. OBJECTIVE: Contribute to the long-term data around weight loss, comorbidity, and complication outcomes of BPD-DS SETTING: Academic medical center, USA METHODS: A retrospective study included patients undergoing laparoscopic BPD-DS between 2008 and 2014 to allow for ≥ 10-year follow-up. Baseline characteristics, intraoperative data, weight loss outcomes, obesity-related medical condition remission and recurrence, and complication rates were collected. Statistical analysis included t-tests, Pearson's Chi-Square test, Kaplan-Meier curves, linear mixed models and multivariate regression. RESULTS: Ninety-six patients were included with a mean follow-up period of 11.6 ± 4.2 years and 60.5% follow-up rate at 15 years. Significant body mass index (BMI) reductions (P < .001) were observed at every time point. Percentage total weight loss (%TWL) and excess BMI loss were consistently > 20% and >50%, respectively, over the entire follow-up period. A longer common channel (150 cm) was associated with a lower %TWL. Among the comorbidities tracked, patients with diabetes experienced the highest remission rate (88.6%), followed by hyperlipidemia (63.6%), hypertension (63.0%) and sleep apnea (59.0%). Early and late complication rates were 27.1% and 45.8%, respectively. Seven patients needed revisional surgery for severe malnutrition, bowel obstruction, intussusception, and duodenoileostomy stenosis. Nutritional deficiencies were frequently encountered. CONCLUSION: BPD-DS offers sustainable weight loss and obesity-related medical condition remission outcomes. Its safety profile warrants consistent follow-up to manage nutritional problems.
Martínez-Montoro JI, Pinazo-Bandera JM, García-Serrano S
… +12 more, García-Almeida JM, Ocaña-Wilhelmi L, Moreno-Ruiz FJ, Soler-Humanes R, Ruiz-Campos N, Sancho-Marín R, García-Cortés M, Muñoz-Garach A, Fernández-García JC, García-Fuentes E, Tinahones FJ, Garrido-Sánchez L
BACKGROUND: Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) share common pathophysiological mechanisms and exert reciprocal influences on each other. Bariatric surgery (BS) is t...BACKGROUND: Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) share common pathophysiological mechanisms and exert reciprocal influences on each other. Bariatric surgery (BS) is the most effective treatment for the improvement and resolution of both conditions; however, little is known about the role of MASLD in diabetes remission following BS. OBJECTIVE: We evaluated the Hepamet fibrosis score (HFS), a noninvasive scoring system used to assess the risk of liver fibrosis, for this endpoint, hypothesizing that a preoperative HFS < .12 (low risk for advanced fibrosis) would be associated with a higher likelihood of diabetes remission, as earlier stages of liver disease may have a positive influence on glycemic outcomes. SETTING: University hospital (two-center). METHODS: In a retrospective observational analysis of a prospectively collected cohort of 145 adults with T2D undergoing BS, we evaluated the association between the preoperative HFS and diabetes remission at 1 year. RESULTS: Among participants with a HFS < .12, 53 out of 72 (73.6%) achieved diabetes remission, compared to 38 out of 73 (52.1%) with a HFS ≥ .12, indicating a 41% higher probability of diabetes remission in the HFS < .12 group (RR = 1.41 [95% confidence interval, 1.09-1.83]; P = .007), compared to HFS ≥ .12 group. In the multivariate logistic regression analysis, HFS <.12 was independently associated with diabetes remission, after adjusting for diabetes duration, number of glucose-lowering medications, suboptimal glycemic control (HbA1c ≥ 7%), type of surgery, waist circumference, and percentage of total weight loss. CONCLUSIONS: We report for the first time an association between the preoperative HFS and diabetes remission following BS, potentially complementing existing predictors with a simple, accessible, and inexpensive preoperative biomarker.
BACKGROUND: Originally described in 2007, the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was only endorsed by the American Society for Metabolic and Bariatric Surgery in 2020. Since then, th...BACKGROUND: Originally described in 2007, the single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) was only endorsed by the American Society for Metabolic and Bariatric Surgery in 2020. Since then, the procedure has grown exponentially in popularity. OBJECTIVES: Assess whether broader adoption of SADI-S has led to a change in practice patterns or complications. SETTING: University hospital, US national database. METHODS: This was a retrospective, observational cohort study of SADI-S entries in the 2020 through 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program databases. χ and analysis of variance were applied to determine differences between years for categorical and continuous variables, respectively. Bonferroni correction was applied to adjust for degrees of freedom, and hence a P value < .008 was considered significant. RESULTS: From the years 2020 to 2023, operative SADI-S volume in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database increased over 4-fold from 488 cases to 1963 cases. Utilization of the robotic platform increased from 33.4% to 41.0% (P < .0001). Complication rate decreased significantly in 2021-2022. There was no significant difference between the years in rates of readmission, reintervention, or reoperation. The most common complications following SADI-S include skin and soft tissue infection, transfusion, and unplanned intensive care unit admission. CONCLUSIONS: Despite increased volume of SADI-S in recent years, rates of unadjusted, short-term, composite complications have not increased significantly and are not significantly different from those of Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.