Perioperative bleeding remains one of the most frequent early complications of laparoscopic sleeve gastrectomy (LSG). The present work aimed to provide a thorough and updated systematic review and meta-analysis of the published studies on the use of tranexamic acid (TXA) in LSG. The present study was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. A systematic literature search was conducted in PubMed, Scopus, and Web of Science. The present study analyzed 9 studies. They included 1665 patients. TXA was administered to 842 patients while 823 patients received no intervention or placebo. Pooled analysis revealed significantly shorter operative duration [mean difference (95
Effective organ retraction is essential for safe minimally invasive bariatric surgery. Traditional retraction techniques have notable limitations: rigid external retractors require subxiphoid incisions and are associated with hepatic trauma and biochemical liver injury, while handheld retractors require additional trocars, increasing complications and operative time. The Elastic Intracorporeal Retractor (EICR) was developed as a trocar-free, hands-free multi-organ retraction system. To evaluate the intraoperative performance, technical feasibility, and safety of the EICR in consecutive laparoscopic bariatric procedures. Tertiary care center. This retrospective study included 96 consecutive procedures performed between January 2022 and January 2025 by a single surgeon. The EICR (XNY Medical) was deployed through a standard 10-mm trocar. Primary outcomes included technical performance (first-attempt deployment, insertion time, repositioning). Secondary outcomes assessed safety through intraoperative events and 30-day outcomes. Independent blinded video review by an external surgeon evaluated 40 consecutive cases. The EICR achieved first-attempt deployment in 99
Obesity in women with Polyendocrine Metabolic Ovarian Syndrome (PMOS) is associated with substantial metabolic and reproductive burden. metabolic-bariatric surgery (MBS) is effective for weight loss, yet postoperative responses vary considerably. Identifying distinct weight loss trajectories and their associated metabolic outcomes may enable individualized postoperative management. In this prospective study, women with obesity and PMOS who underwent sleeve gastrectomy were followed at 1, 3, 6, and 12 months postoperatively. Group-based trajectory modeling (GBTM) based on percentage total weight loss (
Bariatric surgery is the most effective treatment for severe obesity. We evaluated whether a 16-week supervised exercise program initiated immediately post-surgery improves weight loss, body composition, cardiometabolic health, inflammation, and physical fitness compared with usual care. In this randomized clinical trial, 80 participants undergoing bariatric surgery were assessed before surgery, 4- and 12-month post-surgery. The intervention consisted of 16 weeks of individually supervised concurrent exercise training initiated 10 days post-surgery, with three 60-min sessions/week including progressive resistance training (50–75
Metabolic and bariatric surgery (MBS) outcomes are reported as weight loss, using percent total weight loss (
Robotic-assisted surgery (RAS) is increasingly used in bariatric practice, yet its impact on outcomes after duodenal switch (DS) remains poorly characterized, and whether operative length (OL) modifies the RAS-outcome association has not been assessed. The present study examines the independent and interactive effects of RAS and OL on 30-day readmission after DS using a national cohort of over 17,000 cases from the MBSAQIP database spanning 2015–2024. We analyzed MBSAQIP data from 2015 to 2024 for patients undergoing laparoscopic DS (CPT 43845), excluding open, endoscopic, hand-assisted, and single-incision, revision, and conversion cases. Multivariable logistic regression assessed predictors of 30-day readmission, with a pre-specified interaction term between RAS and standardized OL to isolate the independent contribution of robotic use. Among 17,615 DS cases, 5,496 (31.2
Bariatric surgery is a common intervention for obesity but faces challenges, particularly due to its link with binge eating disorder (BED) and other psychological factors that impact outcomes. This systematic review of 22 articles from PubMed/Medline reveals a significant association between pre-surgical BED and reduced effectiveness in weight loss, with compulsive eating behaviors often persisting post-surgery. Traits like anxiety, depression, and emotional instability also compromise optimal results. These findings highlight the need for psychiatric interventions, both pre -and post-surgery, alongside continuous psychological support to enhance outcomes. Multidisciplinary approaches are crucial for sustainable results, with further research recommended to assess the impact of comprehensive psychological care, which plays a vital role in improving and maintaining the benefits of bariatric surgery.
Male obesity-associated secondary hypogonadism (MOSH) is common in men with obesity and can improve following metabolic bariatric surgery (MBS). However, the quantitative relationship between postoperative weight loss and biochemical remission of MOSH remains unclear. This study aimed to characterize the nonlinear association between percentage total weight loss (TWL
Single-anastomosis duodeno-ileal bypass (SADI) is an effective revision procedure for patients with suboptimal weight loss after sleeve gastrectomy (SG). However, the clinical value of concomitant revisional SG (ReSG) during revisional SADI remains unclear. This study evaluated the outcomes of revisional SADI with selective ReSG guided by preoperative computed tomography (CT) volumetry. This single-center retrospective study analyzed prospectively collected data of patients who underwent revisional SADI following SG between 2019 and 2023. Preoperative CT volumetry was used to measure gastric tube, antral, and total sleeve volumes. ReSG was selectively performed based on CT-derived volumetric findings and intraoperative assessments. Perioperative outcomes, complications, and weight-loss parameters were reviewed. Twenty-three female patients underwent revisional SADI and completed at least 12 months of follow-up. The mean interval between primary SG and revision was 41.3 ± 21.6 months. ReSG was performed in 20 patients, whereas three underwent SADI only. The mean follow-up duration after revision was 21.4 ± 9.0 months. The mean percent total weight loss (
To evaluate whether documented preoperative mental health (MH) conditions were associated with early postoperative psychiatric events and metabolic outcomes after primary metabolic-bariatric surgery (MBS). A retrospective cohort study of adults who underwent primary MBS at a tertiary UK bariatric centre between April 2021 and March 2024 was conducted. Preoperative MH conditions and postoperative outcomes were identified via review of electronic health records. Comparisons between groups were analysed using Fisher’s exact test and regression models adjusted for age, sex, preoperative BMI, and surgery type. Among 482 patients, 217 (45.0
BACKGROUND:Obesity affects over 42% of U.S. adults, yet access to metabolic and bariatric surgery (MBS) remains limited despite its proven efficacy. While use of GLP-1 receptor agonists has risen in the past three years, MBS volume has declined over 25% during the same period. Reported barriers to MBS include long wait times, societal sigma, fear of surgery, and insurance restrictions. This study investigated appointment accessibility and program requirements for patients seeking MBS. METHODS:We conducted a secret shopper study of bariatric surgery centers in North Carolina (n=18) and South Carolina (n=17) June - August 2025. Trained callers contacted each program twice, once posing as a patient with Medicaid and once as a patient with private insurance, to request an initial consultation appointment. Data collected included appointment wait times, required documentation, pre-surgical prerequisites, and administrative barriers. RESULTS:Of the 24 centers successfully contacted, all accepted private insurance and 94.3% accepted Medicaid. Median wait time to appointment was 20 days, with no difference by insurance type. On average, programs required 1.7 calls before reaching a scheduler. Most centers (77.1%,n=27) required pre-appointment steps such as an online application, seminar, or PCP referral. Eleven centers could not be reached due to incorrect contact information, and two offered only online intake forms. CONCLUSIONS:Rather than insurance-related disparities, we found that administrative barriers such as repeated call attempts, inaccurate contact information, and variable prerequisites were the main obstacles to MBS access. The lack of standardization across programs highlights the need to streamline the evaluation process.
Bariatric surgery is an effective treatment for obesity. This study aims to identify demographic factors of weight loss and recurrent weight gain over a 10-year follow-up period. This retrospective observational study includes 2092 patients for overall trends, 1032 patients for predictors of weight loss, and 605 patients for predictors of recurrent weight gain. Percentage total weight loss (
Artificial intelligence (AI) uses in the field of bariatric and metabolic surgery (BMS) have evolved over the past few years. However, published evidence remains limited. AI generally refers to computer systems capable of performing tasks that require human intelligence and cognitive functions. This systematic review aims to evaluate the utility of AI tools in BMS and summarize current applications to establish a common language for bariatric surgeons. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane Handbook for Systematic Reviews of Interventions guidelines. Studies indexed in PubMed, Cochrane, and Web of Science databases were identified using appropriate keywords related to obesity, bariatric procedures, and AI tools from inception until October 2025. Relevant studies’ reference lists were also screened. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. The literature search identified 840 studies, with an additional 25 studies identified through citation screening. After removing duplicates and screening, 88 studies were included, categorized into preoperative, intraoperative, and postoperative AI uses as well as large language models uses. Quality assessment showed overall moderate to high quality. AI uses in BMS remains a supportive rather than a decisive tool. When applied appropriately, AI can assist surgeons and patients. LLMs should be used cautiously for preliminary health education. Societal initiatives should direct future efforts to address research gaps. Improving surgeon AI literacy, collaboration with AI specialists, and establishing national registries will maximize AI’s potential.
One-anastomosis gastric bypass (OAGB) is increasingly adopted worldwide as a primary bariatric procedure. Concerns persist regarding long-term gastroesophageal reflux disease (GERD), bile reflux, and postoperative mucosal injury. We evaluated 5-year endoscopic and histological outcomes after OAGB and their correlation with symptoms and preoperative risk factors. We analyzed 1,172 patients undergoing OAGB at four high-volume bariatric centers between July 2015 and February 2020. Patients with major perioperative complications, reoperations, or incomplete follow-up were excluded. Clinical assessment included the GERD-Health-Related Quality-of-Life (GERD-HRQL) questionnaire and a modified Gastrointestinal Symptom Rating Scale (GSRS) focusing on abdominal pain. Upper endoscopy (UE) with systematic biopsy of the gastric pouch was performed according to a standardized protocol. Mean follow-up was 62 ± 26 months (range 60–84). Mean BMI decreased from 44.31 ± 6.28 kg/m2 to 25.1 ± 11.4 kg/m2, with
Robotic surgery adoption in bariatric surgery has expanded rapidly, yet whether early adopter performance influences subsequent peer adoption remains unknown. To examine the association between index adopter performance characteristics and peer surgeon adoption of robotic bariatric surgery. Retrospective cohort study using the Michigan Bariatric Surgery Collaborative, a statewide quality improvement registry. Adults undergoing primary laparoscopic or robotic bariatric surgery between 2006 and 2025 were included. Peer surgeons were non-index surgeons at robotic-program sites, each assigned to their earliest robotic site. Index adopter characteristics: high surgical volume, low complication rate, fast learning curve, and a composite quality indicator. Primary outcome was peer surgeon adoption of robotic surgery. Analyses included multivariable logistic regression with sensitivity analyses using propensity score matching, inverse probability weighting, and causal forest methods. The cohort included 87,068 procedures by 121 surgeons at 41 hospitals. Among 106 peer surgeons, 50 (47.2
Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among individuals with severe obesity. The triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) is an accessible surrogate marker of insulin resistance, but its association with hepatic steatosis and fibrosis in candidates for metabolic and bariatric surgery remains incompletely defined. This retrospective cross-sectional study included 99 patients undergoing preoperative evaluation for metabolic and bariatric surgery between 2020 and 2024. Hepatic steatosis was assessed by ultrasonography and liver fibrosis by elastography. Associations with TG/HDL-C were examined using categorical analyses and multivariable logistic regression. Because diabetes perfectly predicted hepatic steatosis, Firth penalized logistic regression was used for the primary adjusted analysis. The cohort included 61 women (61.6
Sleeve gastrectomy (SG) leads to rapid weight loss, marked by reductions in fat mass (FM) and lean soft tissue (LST), contributing to a decline in resting metabolic rate (RMR). The role of early exercise and the relationship between body composition and RMR remain unclear. To evaluate early changes in RMR and body composition after SG, explore the effects of a whole-body vibration (WBV) resistance training intervention, and examine associations between RMR and body composition. Twenty-six participants with severe obesity (61.5
Endoscopic removal of gastric bands after silastic ring vertical gastroplasty (SRVG) has emerged as a viable alternative to surgical revision. Most endoscopic removals require prior spontaneous band erosion into the gastric lumen. For non-eroded bands, self-expanding metal/plastic stents (SEMS/SEPS) have been used to induce erosion but carry risk of migration. We hypothesized that lumen-apposing metal stents (LAMS), with their antimigration flanged design, could safely induce controlled erosion with fewer complications. This study evaluates the feasibility and short-term outcomes of LAMS-assisted band removal. We retrospectively analyzed 10 patients with non-eroding silastic bands and obstructive symptoms (emesis, dysphagia, or regurgitation) who underwent endoscopic band removal using LAMS. LAMS placement was performed to induce controlled erosion and migration of the band into the gastric lumen. A second endoscopy was scheduled at 1–3 months to remove the stent and band. Clinical success was defined as successful band removal without periprocedural complications. All 10 patients underwent successful endoscopic band removal without periprocedural complications and were discharged within 24 h. Four patients (40
Intraperitoneal administration of local anaesthetics (IPLA) is commonly used in laparoscopic surgery as part of multimodal analgesia. This CT included 110 patients. Patients were randomly assigned to receive nebulised ropivacaine either before or after surgery. Pain was assessed using the Visual Analogue Scale (VAS) at multiple postoperative intervals. Secondary outcomes included analgesic consumption, shoulder pain, oral intake tolerance, early mobilisation, and incidence of nausea and vomiting. No significant differences were observed in abdominal pain scores or any of the secondary outcomes between groups, except for reduced shoulder pain 3 hours postoperatively in the postoperative nebulisation group. Under a standardised opioid-free anaesthesia protocol, postoperative pain was minimal and substantially lower than expected. Therefore, the timing of intraperitoneal ropivacaine administration does not appear to be relevant.
Obesity is a highly prevalent chronic disease associated with substantial morbidity, multiple comorbidities, and a significant burden on healthcare systems. Metabolic bariatric surgery (MBS) is effective in achieving weight loss and improving obesity-related comorbidities, potentially reducing pharmacotherapy requirements and overall disease burden. Nevertheless, evidence from Portuguese real-world clinical practice remains limited. Therefore, this study aimed to provide the first Portuguese evaluation of the impact of MBS on pharmacotherapy-related healthcare costs and on the prevalence and burden of obesity-associated comorbidities. A retrospective cohort study was conducted. Annual pharmacotherapy costs and changes in the prevalence and burden of obesity-associated comorbidities, measured using Years Lived with Disability (YLD), were compared before and 3 years after surgery. Three years after MBS, the mean annual pharmacotherapy cost per patient decreased by €56.11 (p < 0.05). Reductions in medication costs were observed for antihypertensive, lipid-lowering, and antidiabetic therapies (all p < 0.05). The prevalence of obesity-related comorbidities also decreased, particularly hypertension, type 2 diabetes mellitus, dyslipidemia and asthma (all p < 0.05). Correspondingly, the estimated burden of disease decreased, with mean YLD declining from 0.022 before surgery to 0.014 3 years after surgery (p < 0.05). Over 3 years of follow-up, MBS was associated with reductions in medication costs, the prevalence of obesity-related comorbidities, and overall disease burden. These findings highlight the clinical and economic benefits of MBS in the management of obesity and its associated conditions over the medium term. Metabolic bariatric Surgery reduced mean annual pharmacotherapy costs by €56.11 per patient over a 3-year follow-up. Significant reductions in medication costs were observed for antihypertensive, lipid-lowering, and antidiabetic therapies after metabolic bariatric surgery. The prevalence of dyslipidemia, hypertension, type 2 diabetes mellitus and asthma decreased by 32
