Gastro-gastric fistula (GGF) is an uncommon but clinically significant complication after Roux-en-Y gastric bypass, presenting with weight regain, epigastric pain, bile reflux, or recurrent marginal ulceration. Although multiple endoscopic and surgical techniques have been described, comparative outcome data remain limited. We conducted a systematic review and meta-analysis of studies published between 1990 and 2025 evaluating endoscopic and surgical management of GGF. Seventy-six studies underwent full-text assessment for eligibility, and nine studies were eligible for quantitative analysis (5 endoscopic series, n=127; 4 surgical series, n=65).Endoscopic therapy achieved durable fistula closure in 29.9% of patients, with a low major adverse event rate (1.6%). Surgical revision demonstrated 100% clinical success, with a 26.2% postoperative complication rate and no procedure-related mortality. Random-effects modeling yielded consistent pooled estimates with low statistical heterogeneity.These findings suggest that endoscopic management offers an excellent safety profile but limited long-term durability, whereas surgical revision was associated with higher rates of durable fistula closure at the cost of higher perioperative morbidity. Given the observational nature of the available evidence, these findings should be interpreted cautiously and should not be considered evidence of definitive treatment superiority. Treatment selection should therefore be guided by fistula characteristics, chronicity, and patient risk profile. Standardized reporting and prospective evaluation of emerging endoscopic and hybrid techniques are needed to optimize management strategies.
BACKGROUND:Conversion bariatric operations are increasing and now comprise nearly 10% of procedures nationally, yet their 30-day risk compared with primary operations remains poorly characterized at the pathway level. OBJECTIVES:To estimate the adjusted excess 30-day serious adverse event (SAE) risk of conversion versus primary bariatric operations of the same final anatomy, and to identify which pathways carry the highest risk. SETTING:National Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use File (PUF), 2020 to 2024. METHODS:We performed anatomy-stratified logistic regression with marginal standardization on 949,507 bariatric operations (94,828 conversions). The primary outcome was a 17-component composite SAE. Adjusted risk differences (RDs) per 1000 were computed for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion with duodenal switch (DS)/single-anastomosis duodeno-ileal (SADI) strata, and a within-conversion model identified associated factors. RESULTS:Conversion was associated with higher adjusted 30-day SAE risk across all anatomies: SG (RD 18.2 per 1000 [95% confidence interval, CI: 15.0-21.3], number needed to harm [NNH] 55), RYGB (22.1 [19.5-24.7], NNH 45), and DS/SADI (17.5 [9.4-25.7], NNH 57). The excess was concentrated in utilization events (reoperation, reintervention, and readmission) and selected technical complications, such as leak, organ-space infection, and bowel obstruction. Among conversions, a prior RYGB carried the highest risk (adjusted odds ratio [aOR]: 2.54 versus a prior sleeve). The excess showed no detectable change across study years. CONCLUSIONS:Conversion operations carry a clinically meaningful excess 30-day SAE risk that is greatest after a prior gastric bypass. Conversion status should be treated as a distinct risk category rather than benchmarked against primary procedures alone.
Background Obesity is the primary risk factor for type 2 diabetes mellitus (T2DM), characterized by progressive loss of pancreatic function. Genetic variants in key genes, such as GLP1R and TCF7L2, play a crucial role in glycemic control, and dysfunctions may impair insulin secretion by pancreatic β-cells. Objectives: To evaluate the influence of GLP1R and TCF7L2 genetic polymorphisms on T2DM remission in patients undergoing Roux-en-Y gastric bypass (RYGB). Setting: University Hospital, Brazil. Methods: This study was approved by the ethics committee (no. 6.158.558) and included 70 patients who underwent RYGB. Blood samples were collected for laboratory and genetic analyses. Genomic DNA was extracted and analyzed via Real-time PCR using TaqMan probes. Statistical analyses were performed using SPSS 29.0, including Student’s t-test, Spearman correlation, Fisher’s exact test, and Chi-square test (p ≤ 0.05). Results: The GLP1R rs10305420 polymorphism was associated with decreased proportional weight loss over time and increased HbA1c (%) after surgery (p = 0.04). The TCF7L2 rs7903146 polymorphism was associated with increased postoperative glycated hemoglobin (p = 0.036). Conclusions: The GLP1R rs10305420 variant reduces weight loss and increases HbA1c (%) after RYGB. The TCF7L2 rs7903146 variant also increases HbA1c (%) and reduces T2DM remission following RYGB.
Background The global incidence of gallstone disease is rising in parallel with increasing obesity rates. Previous studies indicate a higher complication risk for cholecystectomy performed in patients with previous bariatric surgery; however, this is debated. Objectives To compare complication rate of cholecystectomy between patients with previous bariatric surgery and nonbariatric controls. The primary objective is 30-day complication rate and secondary objectives are 30 days to 1 year complication rate and the presence of persistent or new abdominal complaints. Setting Retrospective cohort study conducted at a teaching hospital in the Netherlands, including all patients who underwent cholecystectomy between 2019 and 2022 after previous bariatric surgery, with time-matched nonbariatric cholecystectomy controls. Methods A 1:2 comparison between cholecystectomy patients with previous bariatric surgery and controls. Results The bariatric surgery cohort included 133 patients and the control cohort 259 patients. The primary outcome 30-day complications after cholecystectomy was higher among postbariatric cases compared to controls (33.1% vs 16.6%, p<0.001, chi-square test, OR 2.48 (95% CI 1.52 - 4.05)). Complications between 30-days and one year was also significantly higher among postbariatric patients (18.6% vs 6.2%, p <0.001). There was no clear difference in major complications (6.0% vs 4.6%, p = 0.73). Abdominal complaints 1 year after cholecystectomy were significantly more reported in postbariatric cases compared to nonbariatric controls (32.6% vs 11.2%, p <0.001). Conclusions Complications after cholecystectomy is more frequent in patients with previous bariatric surgery compared to nonbariatric controls. However, the rate of major complications is similar.
Background Patients who undergo Roux-en-Y gastric bypass (RYGB) can develop anastomotic marginal ulcers, which can lead to other complications such as stricture, bleeding, or perforation. Objective To examine if patients undergoing conversion of sleeve gastrectomy to RYGB (SG-to-RYGB) were at higher risk of marginal ulceration than a cohort of primary RYGB patients. Setting Cleveland Clinic Health System in the United States Method This retrospective study included patients who underwent primary RYGB or SG-to-RYGB at an academic health system between 2015 and 2023. Follow-up ended in March 2025. The Kaplan-Meier method estimated time to incident marginal ulcer. Results The study included 1,910 patients who underwent primary RYGB and 202 patients who underwent SG-to-RYGB. During the follow-up time of 3.8±2.9 years, 275 primary RYGB patients and 40 SG-to-RYGB patients developed a marginal ulcer. The cumulative incidence of marginal ulcer at 5 years was 16% (95% CI, 14%-18%) in the primary RYGB group and 27% (95% CI, 18%-35%) in the SG-to-RYGB group. The cumulative incidence of marginal ulcers at 8 years was 20% (95% CI, 17%-22%) in the primary RYGB group and 35% (95% CI, 20%-47%) in the SG-to-RYGB group (P=0.01). In the SG-to-RYGB group, the cumulative incidence of marginal ulcer between patients who underwent RYGB primarily for GERD versus for inadequate weight loss following SG was not statistically significant. Conclusion Follow-up data up to 8 years indicate that approximately 20% of patients who undergo primary RYGB and 35% of those who undergo SG-to-RYGB may develop marginal ulceration. Given role of antrum in acid secretion, future clinical trials could potentially test if antrectomy at the time of conversion of SG-to-RYGB has the potential to decrease rate of marginal ulceration.
Helicobacter pylori (HP) infection and gastric intestinal metaplasia (GIM) are commonly identified during the evaluation of patients undergoing metabolic and bariatric surgery (MBS) and carry important clinical implications. However, MBS-specific guidance addressing preoperative evaluation, eradication strategies, procedural selection, and long-term risk mitigation remains limited. We conducted a narrative review supported by a structured literature search and U.S. society guideline documents to synthesize evidence from the gastroenterology and MBS literature and to propose a pragmatic clinical decision framework for contemporary practice. Particular emphasis was placed on preoperative endoscopic findings; approaches to HP testing, eradication, and confirmation of cure; associations with perioperative outcomes; risk of marginal ulceration; feasibility of postoperative gastric surveillance; and the risk of non-cardia gastric malignancy following MBS.Routine high-quality preoperative endoscopy with systematic gastric biopsies frequently identifies HP infection and/or GIM, findings that may alter both medical and surgical management. When HP infection is detected, treatment should be completed and eradication confirmed, as persistent infection appears to be associated with higher rates of marginal ulceration following Roux-en-Y gastric bypass (RYGB). The presence of GIM introduces considerations related to long-term gastric cancer risk and the feasibility of postoperative surveillance, both of which are significantly influenced by surgical anatomy.In summary, HP infection should be systematically tested for, treated, and eradication confirmed prior to MBS. In patients with GIM, procedure selection should balance metabolic effectiveness with the ability to perform postoperative surveillance and mitigate long-term malignancy risk. In this context, sleeve gastrectomy or RYGB with concomitant resection of the gastric remnant may be appropriate in carefully selected patients.
BACKGROUND:As bariatric practice shifts toward sleeve gastrectomy (SG) and mini gastric bypass (MGB), the impact of bariatric procedure type on subsequent body contouring outcomes remains unclear. OBJECTIVES:To compare abdominoplasty complication profiles across 4 bariatric procedure types and identify independent predictors of postoperative complications. SETTING:Single tertiary academic medical center, Shamir Medical Center, Tzrifin, Israel. METHODS:A retrospective cohort study reviewed 102 patients undergoing abdominoplasty following massive weight loss (2020-2024). Patients were stratified by antecedent bariatric procedure: SG (n = 39), MGB (n = 34), laparoscopic adjustable gastric banding (LAGB) (n = 25), and Roux-en-Y gastric bypass (n = 4). The primary outcome was 90-day complication rate. Multivariate logistic regression identified independent predictors adjusting for age, smoking, diabetes, and total body mass index change. RESULTS:Overall 90-day complication rate was 23.5%, with no difference between procedure types (P = .99). MGB patients presented earliest (median 2.0 years) and LAGB latest (12.5 years; P < .001). Surgical site infection occurred only in restrictive groups (SG 10.3%, LAGB 8.0%; 0% in malabsorptive groups, P = .27) and MGB showed a nonsignificant hematoma trend (14.7% versus 5%-8%, P = .47). Total body mass index change was the sole independent predictor of complications (odds ratio: 1.12 per kg/m2; 95% confidence interval: 1.03-1.22; P = .007). Subgroup and complication-subtype comparisons were underpowered; nonsignificant procedure differences should be regarded as hypothesis-generating. CONCLUSIONS:Abdominoplasty complication risk is determined by magnitude of weight loss rather than bariatric procedure type. Procedure-specific differences in infection and hematoma patterns merit further investigation.
BACKGROUND:Metabolic and bariatric surgery (MBS) is associated with sustained weight loss and metabolic improvement. However, the understanding of its long-term effects on skeletal health remains incomplete, particularly with respect to different surgical procedures. OBJECTIVES:This study aimed to evaluate long-term changes in bone metabolism, bone mineral density (BMD), and fracture risk after sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB). SETTING:University hospital. METHODS:In this retrospective cohort with prospective long-term follow-up, 60 patients (20 RYGB, 20 OAGB, and 20 SG) underwent primary MBS. Dual-energy X-ray absorptiometry-derived bone densitometry and bone metabolism markers were assessed preoperatively and after a mean follow-up of 10.1± 2.5 years. Measurements included BMD, T-score, and z score at lumbar spine and femoral neck. Ten-year fracture probability was estimated using the FRAX (Fracture Risk Assessment tool) score. RESULTS:Bone metabolism markers largely remained within reference ranges throughout follow-up. Serum vitamin D levels increased significantly after all procedures reflecting postoperative supplementation. In contrast, significant reductions in femoral BMD was observed after all three procedures (SG: .99 ± .14 to .49 ± .17 g/cm2, P = .03; RYGB: 1.09 ± .80 to .59 ± .17 g/cm2, P = .02; OAGB: 1.11 ± .18 to .53 ± .13 g/cm2, P = .01), whereas lumbar spine BMD showed no significant change. FRAX-estimated 10-year risk for major osteoporosis and hip fractures was elevated at long-term follow-up. CONCLUSIONS:Despite largely preserved biochemical bone markers, substantial long-term structural bone loss and increased fracture risk were observed after MBS. These findings support the consideration of routine postoperative bone health surveillance following MBS to allow early therapeutic intervention when indicated.
BACKGROUND:Obesity is a global health crisis associated with increased morbidity and mortality, primarily due to cardiometabolic complications such as type 2 diabetes mellitus and cardiovascular disease. While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained traction as pharmacologic interventions for weight loss and glycemic control, metabolic and bariatric surgery (MBS) remains a more established modality with durable long-term outcomes. Direct comparative effectiveness data evaluating their relative associations with mortality, cardiovascular outcomes, and glycemic control remain limited. OBJECTIVES:To systematically review and quantitatively synthesize observational comparative effectiveness evidence evaluating mortality, major adverse cardiovascular events, and glycemic outcomes among patients with obesity treated with MBS versus GLP-1 RA therapy. SETTING:Systematic review and meta-analysis of observational comparative effectiveness studies. METHODS:A systematic review and meta-analysis were performed on observational comparative effectiveness cohort studies evaluating outcomes among patients with obesity treated with either MBS or GLP-1 RAs. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Joanna Briggs Institute critical appraisal checklist. A systematic search of Medline (via PubMed), Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was conducted in February 2025 to identify studies reporting all-cause mortality, major adverse cardiovascular events, or hemoglobin A1C outcomes. Pooled relative risks (RRs) for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes were calculated using random-effects models. RESULTS:Six retrospective cohort studies involving 208,751 patients were included. In pooled analysis, MBS was associated with a significant reduction in major adverse cardiovascular events compared with GLP-1 RA therapy (RR = .59; 95% confidence interval [CI]: .46-.77). For all-cause mortality, MBS was associated with a nonsignificant trend toward lower risk compared with GLP-1 RA therapy (RR = .66; 95% CI: .41-1.07). The pooled WMD in final A1C favored MBS over GLP-1 RA therapy (WMD = -1.31%; 95% CI: -1.66 to .96). CONCLUSIONS:Both MBS and GLP-1 RA therapies provide important cardiometabolic benefits for individuals with obesity. MBS was associated with more favorable cardiovascular and glycemic outcomes, with a nonsignificant trend toward reduced all-cause mortality. Both treatment strategies remain important components of contemporary obesity management.
Introduction Gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) can be challenging to manage, with conversion to Roux-en-Y gastric bypass (RYGB) as a common surgical therapy. Objectives To evaluate an algorithmic approach for identifying alternatives to SG conversion to RYGB for GERD. Setting This is a single-center, retrospective review of all consecutive patients with persistent GERD after SG between 01/2015 and 07/2021. Methods After lifestyle optimization, patients underwent esophagram, manometry, Bravo pH studies, and esophagogastroduodenoscopy. Thereafter, the algorithm was followed to determine intervention. Prospective data was collected in an institutional database with long-term follow-up comparisons. Results 64 patients were managed (mean age 46 years; 92% female). Average time from index SG to surgical intervention was 4.04 years and mean follow-up was 5.8 years. Procedures included conversion to RYGB (n=41), of which 26 had concomitant hiatal hernia repair (HHR), magnetic sphincter augmentation (n=19), of which 12 had concomitant HHR, HHR alone (n=3), and radiofrequency ablation (n=1). Average BMI was higher for those converted to RYGB (41.4 vs. 32.5). Average pre-op GERD-HRQL improved from 38.9 to 9.3 at follow-up and high-dose/daily PPI use fell from 95% pre-op to 64% post-op, with 28% off PPIs at long-term follow-up. Outcomes did not differ by procedure type (p=0.455 and 0.817, respectively). 4 patients showed no GERD-HRQL improvement, with no association with procedure performed. (p=0.455). Conclusions Utilizing a rigorous protocol, 36% of patients with GERD after SG were spared conversion to RYGB with excellent long-term outcomes, as demonstrated by improved GERD-HRQL scores and reduced PPI use.
BACKGROUND:Heart failure (HF) with preserved ejection fraction (HFpEF) disproportionately affects women, with obesity serving as a significant risk factor. Metabolic and bariatric surgery (MBS) has been associated with reduced risk of HF development and may reverse cardiac geometry and metabolic abnormalities that contribute to impaired cardiac function through weight loss dependent and independent mechanisms. However, the impact of MBS on early patient reported outcomes of HF in female patients remains understudied. OBJECTIVE:The purpose of this pilot study was to determine the early impact of MBS on female patient reported outcomes for HF. SETTING:Academic Medical Center, USA. METHODS:Female patients with morbid obesity were recruited from our institution between 2022 and 2025. They were evaluated in a multidisciplinary fashion, consented, and scheduled for a sleeve gastrectomy (SG) prior to screening and study enrollment. Female patients with and without HFpEF or diastolic dysfunction (DD) were included in the study. Inclusion criteria involved adults 18-60 years of age without HF with reduced ejection fraction. Patients completed the Patient Reported Outcomes Measurement Information System Heart Failure 27 (PROMIS HF 27) profile to evaluate psychometric and physical health characteristics 2weeks before and 6weeks after surgery. The primary endpoint was the change from baseline in the PROMIS HF 27 profile. RESULTS:A total of 27 female patients consented to and enrolled in the study. Six subjects had HFpEF/DD and 21 patients were control subjects. Demographic variables between HFpEF/DD and control groups were similar except for HFpEF/DD patients being older than controls (52.3 ± 4.2 versus 42.3 ± 10.4, P = .002). There were no statistically significant adverse outcomes within the 30-day postoperative period for both groups. Six weeks postoperatively, control subjects showed improvements in PROMIS HF 27 summary scores including physical health (68.5 ± 22.3 versus 81.3 ± 17.3 P < .001), mental health (61.2 ± 19.6 versus 68.3 ± 12.9, P = .038), 56.3 ± 24.9 versus 67.1 ± 14.5, P = .03), social health (75.0 ± 30.0 versus 86.1 ± 20.2, P = .034), and overall health (68.3 ± 22.1 versus 79.3 ± 14.9, P = .001). HFpEF/DD patients demonstrated improvements in physical health (52.7 ± 28.1 versus 64.3 ± 25.0, P = .02) and overall health outcomes after surgery (53.1 ± 30.6 versus 66.4 ± 19.8 P = .05). CONCLUSIONS:MBS, specifically SG, appears to be associated with improvements in patient reported HF outcomes among female patients with obesity. Female patients with HFpEF/DD specifically reported meaningful changes to physical and overall health, including a statistically significant reduction in dyspnea, highlighting a tangible improvement in early, symptom burden in this high-risk population. Finally, the observed improvements in various HF outcomes among control patients highlight the intricate relationship between HF symptoms and obesity itself which can be positively influenced by MBS. These findings underscore the benefits of MBS in enhancing quality of life and cardiopulmonary symptom burden in women with obesity while also highlighting distinct postoperative response patterns in patients with HFpEF/DD.
BACKGROUND:While pharmacologic weight loss therapies like glucagon-like peptide-1 receptor agonists (GLP-1RAs) have increased in popularity, body contouring patients' utilization of other weight loss modalities remains unclear. OBJECTIVES:This retrospective cohort study examined the weight loss modalities used by body contouring patients and their impacts on procedure choice and surgical outcomes. SETTING:University Hospital, United States. METHODS:The TriNetX Research Network was queried for patients who received abdominoplasties, panniculectomies, thighplasties, and brachioplasties between 2012 and 2024. The incidence and prevalence of weight loss modalities were extracted. Trends in weight loss modality utilization were evaluated by Mann-Kendall test. RESULTS:A total of 27,443 body contouring patients were included. Bariatric surgery (15.86%) was the most prevalent weight loss modality. Bariatric surgery (τ = .87, P < .001), naltrexone (τ = .87, P < .001), phentermine (τ = .82, P = .001), and liraglutide (τ = .78, P = .002) demonstrated the strongest increases in utilization overall. Subgroup analysis demonstrated increasing utilization of semaglutide among GLP-1RA users and increasing utilization of sleeve gastrectomy and gastric bypass among bariatric surgery recipients. Patients utilizing bariatric surgery (95.86% vs 92.62%, P < .001) and phentermine (94.29% vs 92.62%, P = .009) had significantly higher rates of abdominal contouring than non-medical weight loss controls. Bariatric surgery recipients also had lower rates of extremity contouring than controls (7.67% vs 9.31%, P = .003). CONCLUSIONS:Body contouring patients utilize a variety of surgical and pharmacologic weight loss modalities. Patients using potent weight loss modalities may more frequently undergo abdominal contouring compared to extremity contouring, potentially due to preferential abdominal skin laxity from massive weight loss.
BACKGROUND:Metabolic and bariatric surgery (MBS) is the most effective treatment for sustained weight loss, yet postoperative outcomes vary. Attention-deficit/hyperactivity disorder (ADHD) may influence eating behaviors and outcomes, but its role after MBS remains unclear. OBJECTIVES:To examine changes in eating behaviors and ADHD symptoms from before surgery to 4 and 12 months after surgery, compare baseline profiles by ADHD symptom level, and test whether ADHD symptoms moderate associations between eating behaviors and 12 months excess weight loss (EWL). SETTING:University hospital bariatric surgery center, Quebec City, Canada. METHODS:Seventy-five adults with severe obesity undergoing MBS were assessed at baseline and at 4 and 12 months postoperatively. Measures included the Three-Factor Eating Questionnaire, Adult ADHD Self-Report Scale, Beck Depression Inventory II, and anthropometric data. Repeated-measures analyses examined longitudinal changes, and multiple linear regression models tested moderation. RESULTS:Mean EWL was 46.8% at 4 months and 75.3% at 12 months. Dietary restraint increased from baseline to 4 months and remained stable at 12 months, whereas disinhibition decreased and remained low. ADHD symptoms remained stable across time. At baseline, participants who screened positive for ADHD (n = 6, 8.0%) showed distinct profiles, including higher dietary restraint, lower disinhibition, lower body mass index, and more depressive symptoms. ADHD symptoms did not moderate associations between eating behaviors and EWL. However, higher dietary restraint at baseline and 4 months predicted less 12-month EWL. CONCLUSIONS:ADHD symptoms were associated with distinct baseline psychobehavioral profiles but did not influence weight loss outcomes. Dietary restraint emerged as a clinically relevant predictor of poorer 12-month EWL after MBS.
BACKGROUND:The reliability of noninvasive methods to detect metabolic dysfunction-associated steatotic liver disease and metabolic-associated steatohepatitis (MASH) or advanced liver disease remains uncertain. OBJECTIVES:To test the hypothesis that routine liver biopsy (LB) during metabolic and bariatric surgery (MBS) at an academic center would identify a high prevalence of MASH with minimal operative risk. SETTING:Single-center metabolic and bariatric surgery accreditation and quality improvement center in Louisiana and national metabolic and bariatric surgery accreditation and quality improvement data, 2020-2023. METHODS:Institutional and national MBS cases were analyzed. Patients aged <18 years, open procedures, conversions/revisions, and missing biopsy results (institutional data) were excluded. LB characteristics and case outcomes were examined using logistic regression to determine the association of postoperative complications. RESULTS:A total of 980 institutional cases and 695,343 national cases were identified. Local routine LB prevalence was 48%, while national prevalence for LB was 3.5%. Routine LB locally revealed steatosis in 71.8%, nonalcoholic steatohepatitis in 31.6%, and fibrosis in 20.6%. Black race was associated with lower odds of steatosis (odds ratio [OR]: .34), MASH (OR: .28), and fibrosis (OR: .45). In contrast, hypertension (OR: 1.93) and insulin-dependent diabetes (OR: 2.66) were associated with increased nonalcoholic steatohepatitis risk. Postoperative complications were not different between routine LB and non-LB patients locally (P > .05). Cases with LB nationally had slightly lower estimates of complications, although small but significant differences were observed with the larger sample. CONCLUSIONS:Metabolic dysfunction-associated steatotic liver disease/MASH is highly prevalent in MBS. Not only is LB safe and not risk prohibitive but it also identifies advanced liver disease that is generally poorly detected preoperatively and can affect postoperative treatment and outcomes.
BACKGROUND:Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and one-anastomosis gastric bypass (OAGB) are increasingly used bariatric procedures, but high-quality comparative evidence remains limited. OBJECTIVES:To compare 1-year efficacy and safety outcomes of SADI-S and OAGB as primary bariatric procedures in patients with severe obesity. SETTING:Secondary care bariatric surgery center. METHODS:This was a single-center, prospective, randomized, single-blind controlled trial. Ninety-nine patients aged 18-65 years with body mass index (BMI) 45-50 kg/m2 were enrolled between 2023 and 2024; 90 underwent surgery (43 SADI-S; 47 OAGB). Patients were randomly assigned (1:1) using a computer-generated sequence. The primary outcome was excess weight loss (EWL) at 1 year. The secondary outcomes included total weight loss (TWL), BMI, late complications (>30 days), comorbidity resolution, nutritional deficiencies, and quality of life. RESULTS:At 1 year, no significant differences were observed between groups in EWL (84.34% vs 79.61%; P = .209), TWL (35.85% vs 33.02%; P = .075), or BMI (27.93 vs 28.92 kg/m2; P = .168). Comorbidity resolution rates were comparable. Nutritional deficiencies were infrequent (7.3% vs 4.3%; P = .878), with all cases related to iron deficiency. Late complications were significantly more frequent after OAGB (35.4% vs 7.1%; P = .0003), mainly related to bile reflux and managed conservatively or endoscopically. SADI-S was associated with fewer complications but included two cases requiring surgical reintervention. One death occurred in the SADI-S group and was not directly attributable to the procedure. Quality of life improved similarly in both groups. CONCLUSIONS:SADI-S and OAGB achieved comparable weight loss and metabolic outcomes at 1 year in patients with BMI 45-50 kg/m2 but showed distinct complication profiles. OAGB was associated with a higher rate of bile reflux-related events, whereas SADI-S had fewer but more severe complications. These findings support an individualized approach to procedure selection. Longer-term follow-up is required.
BACKGROUND:Patient-Reported Outcomes Measurement Information System (PROMIS) 29 may be a valuable questionnaire to assess patient-reported outcomes after metabolic and bariatric surgery (MBS), but its psychometric properties in this context remain unclear. OBJECTIVES:To assess the internal consistency, construct validity, and responsiveness of PROMIS-29 as a measure of recovery and longer-term outcomes after MBS. SETTING:Two university hospitals and a private surgical clinic in Canada. METHODS:Patients undergoing laparoscopic MBS completed the PROMIS-29 preoperatively, during the recovery period (postoperative weeks 1, 2, 3, and 4), and longer-term follow-up (postoperative months 6 and 12). Physical Health Summary (PHS) score and Mental Health Summary (MHS) score were derived from T-scores. Internal consistency was appraised using Cronbach's alpha. Construct validity and responsiveness were assessed via a priori hypotheses targeting known-group differences and expected postoperative health trajectories. Each measurement property was deemed acceptable if ≥ 75% hypotheses were confirmed. RESULTS:351 patients were included (age 44 ± 11, body mass index 45 ± 8, 77% female, 71% sleeve gastrectomy). Internal consistency of PHS and MHS was acceptable (alpha > .7). Construct validity during recovery was limited (PHS 3/8 [38%] and MHS 4/8 [50%] hypotheses confirmed). In the longer term, construct validity was not supported (PHS 0/6 and MHS 0/4). Responsiveness of PHS and MHS was limited in the recovery period (1/4 [25%]) but supported in the longer term (2/2 [100%]). CONCLUSIONS:PROMIS-29 scores were responsive to long-term health improvements after MBS but failed to differentiate groups that were expected to have distinct outcomes. Context-specific tools may be better suited to capture health trajectories post-MBS.
