BACKGROUND:Intestinal hypoxia-inducible factor 1α (HIF1α) orchestrates epithelial adaptation to luminal hypoxia and has been linked to metabolic homeostasis, yet its contribution to obesity, metabolic dysfunction-associated steatotic liver disease (MASLD), and bariatric surgery-mediated benefits remain unclear. METHODS:In this study, we combined diet-induced models and genetic approaches to interrogate intestinal epithelial HIF1α function in obesity/MASLD progression and in the metabolic improvements elicited by sleeve gastrectomy (SG). RESULTS:Intestinal epithelial HIF1α deletion did not alter diet-induced weight gain, glucose homeostasis, or the metabolic and hepatoprotective effects of SG under either High-fat diet (HFD) or high-fat/high-fructose diets (HFFD) feeding. Notably, despite largely unchanged systemic metabolic phenotypes, intestinal HIF1α deficiency increased hepatic triglyceride and cholesterol accumulation and reshaped hepatic metabolic gene expression, indicating a selective impact on liver lipid handling. In contrast, activation of intestinal HIF1α protected against diet-induced obesity and hepatic steatosis. 16S rRNA profiling showed that intestinal HIF1α activation was associated with a distinct microbial shift, including enrichment of Ruminococcus and reduction of Desulfovibrio. CONCLUSIONS:Although activated after SG, intestinal epithelial HIF1α is not required for SG-induced metabolic improvements but exerts context-dependent protection against diet-induced obesity and hepatic steatosis, accompanied by gut microbial remodeling.

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

BackgroundMetabolic bariatric surgery (MBS) such as Vertical Sleeve Gastrectomy (VSG) is the most effective intervention for obesity but commonly results in iron deficiency, inadequately managed by oral iron supplementation. This study aimed to investigate mechanisms underlying the inefficacy of oral iron supplementation post-VSG, evaluate clinical relevance through patient studies, and test the therapeutic potential of curcumin, a hepcidin inhibitor, to improve iron management.MethodsDiet-induced obese mice underwent VSG or sham surgery and received either regular-iron or iron-rich diets postoperatively, with or without curcumin supplementation. Systemic and tissue iron metrics, expressions of genes and proteins involved in iron metabolism were analyzed. Clinically, we evaluated circulating hepcidin levels in VSG patients developing iron deficiency vs. matched controls without deficiency at 6-months post-surgery.ResultsIn mouse models, VSG induced persistent iron deficiency that could not be corrected by oral iron supplementation. VSG increased intestinal dietary iron uptake capacity, yet oral iron triggered a disproportionate rise in hepatic hepcidin. The resulting hepcidin-mediated ferroportin loss traped absorbed iron within enterocytes, hepatocytes, and macrophages, producing persistent systemic iron deficiency despite supplementation. Moreover, curcumin, a hepcidin-suppressive intervention, restored ferroportin protein, mobilized sequestered iron, and rescued serum iron indices while leaving the VSG-induced intestinal iron absorption machinery intact. In patients 6 months after VSG receiving routine oral iron supplementation, those with iron deficiency exhibit higher hepcidin than matched non-deficient controls, and hepcidin levels were inversely correlated with circulating iron levels.ConclusionsThese results reframe post-VSG iron deficiency as a disorder of iron mobilization and regulation, not merely reduced absorption. Clinically, they argue for therapeutic strategies that target the hepcidin-ferroportin axis to restore the efficacy of oral iron supplementation in correcting iron deficiency following MBS.

Type 2 diabetes mellitus (T2DM) frequently coexists with male obesity-associated secondary hypogonadism (MOSH). This study aims to determine the impacts of T2DM on both baseline features and postoperative outcomes after metabolic bariatric surgery in MOSH patients. In this retrospective, two-arm cohort study, patients with MOSH undergoing laparoscopic sleeve gastrectomy (LSG) between January 2021 and June 2025 were stratified by T2DM status and matched 1:1 by age, yielding 174 patients per group. Weight loss, metabolic parameters and sex hormones were assessed at baseline and 12 months post-LSG. Preoperatively, the T2DM group exhibited significantly lower levels of total testosterone (TT) (6.19 vs. 7.13 nmol/L, P < 0.001), free testosterone (FT) (0.16 vs. 0.18 nmol/L, P < 0.05) and bioavailable testosterone (BT) (3.88 vs. 4.27 nmol/L, P < 0.01). Postoperatively, two groups achieved similar weight loss and MOSH remission rates. While TT/FT rose markedly and to similar levels in both groups at 12 months post-LSG (TT: 16.67 vs. 17.09 nmol/L, P = 0.251; FT: 0.34 vs. 0.36 nmol/L, P = 0.195), the T2DM group exhibited persistently lower testosterone bioavailability (BT: 8.28 vs. 8.91 nmol/L, P = 0.013). T2DM exacerbates the androgen deficiency in MOSH. Although LSG produces substantial and comparable weight loss, glycemic control, and rises in testosterone across groups, patients with T2DM show incomplete recovery of testosterone bioavailability post-LSG, underscoring the need for targeted postoperative monitoring of androgen bioavailability in this population.

OBJECTIVE:Metabolic bariatric surgery, such as vertical sleeve gastrectomy (VSG), is the most effective treatment for obesity, yet the molecular mechanisms remain incompletely defined. This study aims to explore the role of hepatic flavin monooxygenase 3 (FMO3) in the metabolic improvements of VSG. METHODS:Hepatic FMO3 was assessed in liver biopsies from human patients. Diet-induced obese mice underwent VSG, targeted hepatic FMO3 inhibition with antisense oligonucleotides, or VSG with concurrent FMO3 knockdown. Outcomes included weight loss, glucose tolerance, insulin sensitivity, serum lipids, hepatic steatosis, circulating bile acid profiling, hepatic gene expression involved in the FXR pathway, and bile acid synthesis/transport. RESULTS:In mouse models, VSG suppressed hepatic FMO3 expression, leading to significant weight loss, enhanced glucose and lipid metabolism, and reduced hepatic steatosis. Inhibition of FMO3 using antisense oligonucleotides recapitulated many of these effects, while silencing FMO3 diminished VSG's metabolic benefits. Clinical data revealed elevated hepatic FMO3 expression in patients with obesity and its downregulation after VSG, correlating with metabolic improvements. Additionally, FMO3 downregulation was associated with alterations in bile acid metabolism and FXR signaling. CONCLUSIONS:Hepatic FMO3 downregulation contributes importantly to the metabolic benefits of VSG. Targeting hepatic FMO3 may offer a nonsurgical strategy to reproduce key clinical benefits of metabolic bariatric surgery.

INTRODUCTION:Laparoscopic sleeve gastrectomy (LSG) has become a common bariatric procedure in China, and the long-term risk of postoperative anemia remains to be estimated. This study aimed to investigate the incidence and risk factors of anemia at different times after LSG in Chinese population. OBJECTIVES:To investigate the incidence of postoperative anemia and its risk factors in a cohort of Chinese patients with obesity undergoing LSG. SETTING:Huashan Hospital, Fudan University, Shanghai, China. METHODS:A retrospective cohort study was conducted on 619 patients who underwent LSG at a tertiary hospital between 2012 and 2022. The incidence of anemia at different postoperative stages was reported, and risk factors were explored using multivariable logistic regression. RESULTS:Among the 619 patients, 567, 436, and 189 participated in 0∼3, 3+∼12, and 12+∼60 months follow-up visits, respectively. The cumulative incidence of anemia for each period were 9.3%, 6.6%, and 9.1% for males, lower than those of 13.5%, 20.6%, and 39.2% for females. During the first 3 months of follow-up, preoperative iron deficiency was associated with a higher incidence of postoperative anemia (odds ratio [OR]: 3.67, 95% confidence interval [CI]: 1.11-12.16), and iron supplementation was associated with a lower risk of anemia among all patients (.46, .27-.77) and female patients (.49, .27-.87). In the period of 3+ - 12 months, females with advanced FIB-4 level (≥1.45, an index for liver fibrosis) had a higher incidence of anemia (5.72, 1.24-26.49). Among males, higher preoperative body mass index (BMI) was associated with a lower risk (.79, .64-.98), while weight loss was positively associated with anemia (1.26, 1.06-1.48). CONCLUSION:Postoperative anemia was frequent in Chinese patients undergoing LSG and was associated with female gender, lower BMI, advanced preoperative FIB-4 level, and a lack of iron supplementation after surgery.

Metabolic and bariatric surgery (MBS) can effectively improve obesity and its related complications, but it may lead to side effects such as iron deficiency (ID) and iron deficiency anemia (IDA). However, the specific risk factors for ID and IDA after laparoscopic sleeve gastrectomy (LSG) remain unclear. We retrospectively enrolled 465 patients who underwent LSG from April 2014 to December 2021. The risk factors for postoperative ID and IDA were evaluated using logistic regression analysis. Patients who underwent LSG from December 2020 to December 2021 were given low-dose iron and vitamin B12 orally based on the iron-containing multivitamin supplementation throughout the year after surgery. We analyzed the incidence of postoperative ID and IDA in patients who received additional prophylactic treatment compared with those who did not. One hundred one (21.7

Early dumping syndrome and postprandial hypoglycemia are common complications following sleeve gastrectomy. However, long-term studies are scarce. We evaluated 122 sleeve gastrectomy patients who underwent surgery between December 2011 and May 2018. Symptoms were assessed using the Dumping Symptom Rating Scale and Edinburgh Hypoglycemia Scoring System questionnaire. Symptom severity was categorized as mild, moderate, or severe based on predefined scoring criteria. The median follow-up time was 7 years. Of 97 patients (79.5

Hyperuricemia is a metabolic disorder associated with obesity. Many studies have reported the effect of bariatric surgery on the decrease of serum uric acid level in patients with hyperuricemia. However, since the update of diagnostic criteria of hyperuricemia, the correlation between preoperative body mass index, postoperative weight changes, and the remission of hyperuricemia in patients with obesity after sleeve gastrectomy requires consensus. One hundred and ninety-three patients with obesity and hyperuricemia who underwent laparoscopic sleeve gastrectomy were enrolled. All patients were followed up for 6 months postoperatively. Subgroup analysis was performed using the tertiles of preoperative body mass index, total weight loss, and excess weight loss to investigate the correlation with the remission of hyperuricemia after sleeve gastrectomy. A total of 193 patients were included in this study. Among them, 123 patients were female and 70 were male. And the mean age was 30.2 ± 7.8 years, preoperative body weight was 116.1 ± 23.3 kg, and the preoperative BMI was 40.5 ± 6.7 kg/m2. 59.1

Although laparoscopic sleeve gastrectomy (LSG) effectively addresses obesity, its outcomes on hyperuricemia (HUA) remission remain inconsistent. We aimed to identify baseline predictors and develop a nomogram for HUA persistence six months following LSG. We retrospectively analyzed patients with obesity and HUA undergoing primary LSG at Huashan Hospital. An independent validation cohort from the Affiliated Hospital of Xuzhou Medical University was included. Clinical data, including demographics, anthropometric measurements, and biochemical markers were analyzed. Logistic regression analyses identified independent predictors of persistent HUA, and a predictive nomogram was developed and externally validated. A total of 631 patients was enrolled in this study. Persistent HUA was observed in 41.8

Purpose To evaluate the impact of laparoscopic sleeve gastrectomy with reconstruction of His angle (LSGRH) on gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG). Materials and Methods Clinical data of patients with obesity who underwent LSG or LSGRH from January 2022 and January 2024 and completed follow-up in time were retrospectively analyzed by propensity score matching (PSM) analysis. Patients were assigned to either LSG group or LSGRH group according to the surgical method. Perioperative indicators, improvement of obesity and severity of GERD were compared in these two groups. Results There were 51 comparable pairs of patients from LSG and LSGRH group enrolled in this study after PSM. There was no significant difference in operative time, volume of intraoperative blood loss, hospital stay after operation, weight loss and severity of GERD 6 months after surgery. Conclusion Under the premise of no increase in operative time, volume of intraoperative blood loss and hospital stay after operation, LSG with reconstruction of His angle cannot prevent the occurrence of de novo GERD compared with LSG.

The aim of this study was to evaluate the short-term efficacy of single-anastomosis duodeno-ileostomy with sleeve gastrectomy (SADI-S) using a 400-cm common limb in Chinese patients with obesity of low BMI (<35 kg/m²) and type 2 diabetes (T2D). Sixteen patients who underwent SADI-S between June 2022 and November 2023 were retrospectively analyzed and evaluated at 6 and 12 months postoperatively. The primary outcome was the rate of diabetes remission (HbA1c < 6.5

The management of a recurrent (symptomatic) hiatal hernia remains controversial. This study aimed to review the outcomes of patients who underwent recurrent repair of hiatal hernias. Thirteen patients who underwent recurrent hiatal hernia repairs at our hospital between 2018 and 2024 were reviewed retrospectively. The postoperative outcomes and complications of these patients were investigated. Thirteen patients were included in this study. The median time of reoperation from the previous hiatal hernia repair was 3 years (IQR, 2.5–5). Patients with a history of only one repair accounted for 76.9

OBJECTIVE:This study aimed to evaluate the weight loss efficacy of semaglutide initiated 6 months after laparoscopic sleeve gastrectomy (LSG). METHODS:This retrospective study included patients undergoing primary LSG. Patients receiving semaglutide (1.0 mg weekly) at 6 months post LSG for 6 months were matched 1:3 with controls not receiving semaglutide, balancing demographics, preoperative BMI, waist-hip ratio, comorbidities, and total weight loss (TWL) at 6 months post surgery. Primary outcomes were absolute and percentage weight loss from 6 to 12 months post LSG. RESULTS:Both the treatment (n = 34) and control (n = 102) groups achieved substantial TWL (23.16% ± 6.50% vs. 23.53% ± 4.87%) at 6 months post LSG. From 6 to 12 months, the treatment group experienced significantly greater absolute (14.03 ± 5.26 kg vs. 5.63 ± 6.25 kg; p < 0.0001) and percentage (12.61% ± 4.11% vs. 4.84% ± 5.18%; p < 0.0001) weight loss than controls. At 12 months, TWL was also higher in the treatment group (35.77% ± 8.35% vs. 28.37% ± 7.41%; p < 0.0001). CONCLUSIONS:Semaglutide initiated 6 months post LSG significantly enhances short-term postoperative weight loss, even among patients who have already achieved substantial initial weight loss. These findings suggest its potential as an effective adjunct therapy for optimizing weight management in early postoperative care.

Gastric greater curvature plication combined with Nissen fundoplication (GGCP + Nissen) has been previously performed, but its efficacy remains uncertain. A single-center retrospective review was conducted on patients with obesity who underwent GGCP + Nissen or sleeve gastrectomy (SG) between January 2016 and December 2022. Both groups were matched for age, gender, and baseline BMI. In the animal experiments, GGCP + Nissen, SG, and sham procedures were performed on Goto-Kakizaki rats, a model of normal-weight rats with T2DM. A total of 75 patients were included in this study, of whom 35 underwent GGCP + Nissen, and 40 underwent SG. Both groups were matched for age, gender, and baseline BMI. The percent total weight loss (

The impact of bariatric surgery on bone density reduction has been well documented, while its effects on paraspinal muscles remain unclear. This study aims to analyze changes in muscle fatty infiltration one year after bariatric surgery in young obese adults. A group of obese patients (obese group) and normal-weight controls (control group), both without a history of spine surgery, were included. Clinical variables including total weight loss and experimental indices were collected for the obese group. MRI-based measurements of fat fraction (FF) and cross-sectional area (CSA) of multifidus muscle (MF), erector spinae (ES), and psoas muscles, as well as T2 value of the whole disc at all disc levels were compared between groups at baseline. For the obese group, these measurements were also compared between preoperative and postoperative. Pearson correlation was used to analyze the relationship between muscle MRI parameters and weight. Fifty-two obese patients (BMI = 38.5 ± 5.6 kg/m2, mean age = 33.15 ± 6.51 years) and 52 age- and sex-matched controls (BMI = 23.5 ± 5.6 kg/m2, mean age = 33.52 ± 3.43 years) were included. Forty obese patients returned for one-year follow-up. At baseline, obese patients exhibited increased FF values in all three muscles and increased CSA in the ES at all disc levels (P < 0.001). While for the MF and psoas, significant increases in CSA were observed only at L4/5 and L5/S1 disc levels (P < 0.05). The obese group also displayed significantly lower T2 values and higher Pfirrmann classification for all five intervertebral discs (all P < 0.05), particularly at higher levels. At follow-up, FF values of the ES and MF significantly decreased only at the L1/2-disc level (P < 0.05). These decreases were not significantly correlated with weight loss (all P > 0.05). However, a significant link was found between changes in high-sensitivity C-reactive protein and FF values of the ES and MF at L1/2 level from preoperative to postoperative (P < 0.05). Significant improvements in muscle fatty infiltration were observed in the ES and MF at higher levels one year postoperatively for obese patients, which may be linked to the improvements of high-sensitivity C-reactive protein.

To review the safety and efficacy of Lap-re-Do technique in the treatment of large parastomal hernia. We retrospectively analyzed the recurrence and complications of 81 patients with large parastomal hernia who underwent Lap-re-Do technique in Huashan Hospital of Fudan University from May 2010 to December 2019. And the patients should be able to complete follow-up. With such criteria, we included 40 Lap-re-Do Keyhole patients and 41 Lap-re-Do Sugarbaker patients. Observation time was defined as time to recurrence, death, or last nonevent visit. In large parastomal hernias, Lap-re-Do had a recurrence rate of 25.9

Purpose We investigated the optimal number of valid measurements (VMs) for the attenuation coefficient (AC) to assess liver steatosis using attenuation imaging (ATI) and explored factors that may affect AC measurement in patients with metabolic dysfunction-associated fatty liver disease (MAFLD).Materials and Methods A total of 139 patients with MAFLD who underwent ATI and liver biopsy were enrolled. Hepatic steatosis was graded as S0-3 according to the SAF scoring system. The AC values from 1, 2, 3, 5, and 7 VMs were compared with the degree of liver steatosis. The correlation between AC values from different VMs was analyzed. The diagnostic performance of AC from different VMs at each steatosis grade was compared. The factors related to AC were identified using linear regression analysis.Results The mean AC values from 1, 2, 3, 5, and 7 VMs were not significantly different between grades S0-3 (p=n.s. for all). Bland-Altman analysis showed the mean difference in AC values of 3 VMs and 7 VMs was 0.003 dB/cm/MHz, which was smaller compared with 2 VMs, and close to 5 VMs. The intraclass correlation coefficients of AC were all > 0.90 among different VM groups. AC values from different VMs all significantly predicted steatosis grade >= S1, >= S2, and S3 without significant statistical differences (p=n.s. for all). The multivariate analysis showed that the hepatic steatosis grade and triglyceride level were factors independently associated with AC.Conclusion Three valid measurements of AC may be adequate to ensure the accuracy and reproducibility of hepatic steatosis assessment. The degree of liver steatosis and the triglyceride level significantly affected AC values.

Sedentary behavior for two years during the coronavirus disease 2019 (COVID-19) pandemic contributes to weight gain. Gut microbiota and blood metabolome are related to body mass index (BMI) and indicate individual metabolic changes. Surgery and exercise are effective weight-loss methods. The precise plasma metabolites and gut microbiota biomarkers involved and the underlying mechanisms are still largely unclear. To address this issue, we analyzed weight gain and weight loss cohorts to identify biomarkers associated with obesity. In the sedentary cohort, 49 subjects were recruited in year 2019. After two years of sedentary behavior during the COVID-19 pandemic, the BMI of 24 subjects significantly increased (Weight gain group), while that of the remnant 25 subjects remained constant (Maintaining weight group). At baseline and two years post baseline, the gut microbiota and blood metabolome, as well as body composition and clinical indicators, were all collected. In weight loss studies, we analyze the plasma metabolome of the two cohorts, including individuals who underwent laparoscopic sleeve gastrectomy (LSG) surgery and exercise intervention. Weight gain through sedentary behavior contributed to the variation of the gut microbiota and plasma metabolites composition. Creatine, phenylalanine and tyrosine exhibited significant positive associations with BMI and fat mass. We further confirmed the association between BMI and plasma metabolites in two weight loss cohorts. By utilizing a linear regression model, we found that 10 metabolites including creatine were correlated with BMI in weight loss individuals. Based on receiver operating characteristic (ROC) curves, creatine exhibited a satisfactory classification performance in regard to predicting weight reduction (AUCLSG = 0.890, AUCSports = 0.840). Moreover, some gut microbiota, including Bifidobacterium angulatum DSM 20098 = JCM 7096 and Rothia dentocariosa M567I could affect BMI through the mediating factor of creatine.

PURPOSE:Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. METHODS:We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. RESULTS:Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25-38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. CONCLUSION:Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.