Despite the technical simplicity of sleeve gastrectomy (SG) and the satisfactory results in terms of weight loss and the development of obesity-related diseases, SG is associated with complications ranging from minor to life-threatening. Splenic artery aneurysm or pseudoaneurysm (SAA or SAP) is a life-threatening condition. This complication is rarely mentioned in the literature in relation to SG, as it typically occurs years after SG. This case report demonstrates how life-threatening this condition can be and what diagnostic and therapeutic options should be investigated. Symptoms of SAA or SAP include unexplained acute shoulder, thoracic or abdominal discomfort that is not cardiopulmonary in origin. In the case of a segmental splenic infarction, a contrast-enhanced ultrasound or preferably a contrast-enhanced CT scan of abdomen is recommended. Angiographic intervention with implantation of a stent graft or coiling should be considered as a treatment option. If angiography fails, surgery should be performed. following ruling out cardiac causes, our patient was discharged following cardiological evaluation for unexplained chest and shoulder pain. A few days later, deteriorating symptoms and unstable hemodynamics led to rehospitalization. After several tests, a SAA after SG explained the pain and unstable situation. This situation could have been avoided if the attending physician had known SG's long-term effects. At initial presentation, the diagnostic tests above should have been done. The progression of the aneurysm treatment would not have been impeded by this.

OBJECTIVE:Obesity surgery (OS) results in substantial, albeit heterogeneous, long-term improvements in weight and mental health, with unclear trajectories and their associations. This study examined multivariate trajectories of weight, psychopathology, and health-related quality of life (HRQOL) after OS, and their prospective association with long-term health outcomes. METHOD:In the prospective multicenter Psychosocial Registry of Obesity Surgery, N = 856 patients were classified into multivariate trajectory classes using latent class linear mixed models, based on assessments of weight, depression, eating disorder psychopathology, and HRQOL at baseline and annually 1-5 years following OS. The prognostic significance of trajectory classes for 6-year follow-up was examined. Multivariate trajectory modeling was compared with univariate weight trajectory modeling for concordance and prognostic significance. RESULTS:We identified three trajectory classes of low (I, 2.8%), medium (II, 89.1%), and high (III, 8.1%) sustainability 1-5 years after OS, indicating high (I) or gradual deterioration (II) or further improvement (III) after initial improvement of indicators. The low sustainability class (I) reached nadir improvements earliest. Consistently, trajectory classes were prospectively associated with differential clinically significant improvement in weight and mental health at the 6-year follow-up. Multivariate trajectory modeling was discordant with univariate weight trajectory modeling and showed greater predictive value for health outcomes at the 6-year follow-up. DISCUSSION:Patients who achieve nadir improvements in weight and mental health early may require clinical attention to prevent long-term relapse. Monitoring changes in the first years after OS appears essential to identify patients in need of additional intervention, ideally using indicators beyond weight, such as mental health.

The present study employed a large scaled multicenter nationwide study data analysis to elucidate the impact of thromboembolism prophylaxis (TEP) in the context of bariatric and metabolic surgery and to investigate the peri- and postoperative complications associated with TEP. A total of 63,909 patients who underwent primary bariatric surgery between 2005 and 2020 were included in the analysis. The data were collected prospectively and multicentrically in the German Bariatric Surgery Registry (GBSR) and subsequently analyzed retrospectively. A p value of ≤ 0.05 was deemed to correspond to a significant result. 96.65

In teaching, obesity and metabolic surgery play only a limited role. However, due to the rapidly increasing number of surgical interventions, communication of knowledge in the study of human medicine as well as in gastroenterological and surgical residency (general and abdominal surgery) is required.Narrative review. · Currently, lectures on obesity and metabolic surgery do not belong to the current surgical curriculum of human medicine at all University Medical Schools, which needs to be absolutely established step by step - based on their topicality and importance in the clinical spectrum of clinical care.. · This rapidly developing special area of abdominal surgery is characterized by specific and diverse interdisciplinarity.. · Multimorbidity, changes in resorption mechanisms but also psychological changes have a substantial impact on the indication and patient outcome.. · The increase in endoscopic, surgical and also robotic interventions and surgical methods in this special field requires a broad knowledge of all surgical disciplines in intervention preparation, perioperative and follow-up management of obesity-associated basic diagnosis. This objective is important even in the study of human medicine and further advanced training.. The inclusion of such complex contents on obesity and metabolic surgery into surgical teaching and into residency of general and abdominal surgery is essential to be future-oriented and prepared for the development of the discipline.

Die zunehmende Prävalenz der morbiden Adipositas geht auch in Deutschland mit einem deutlichen Anstieg adipositas- und metabolisch-chirurgischer Eingriffe einher. Diese sind effektiv, um die klinischen und biochemischen Manifestationen des metabolischen Syndroms positiv zu beeinflussen. Es ist nicht nur die Gewichtsreduktion durch Restriktion und Hypoabsorption, sondern es sind die bisher in ihrer Komplexität nicht verstandenen neurohumoralen Mechanismen, durch die die metabolische Chirurgie verändernd eingreift. Das Verständnis neurohumoraler Mechanismen sowie neue Techniken und Innovationen haben das Spektrum adipositas- und metabolisch-chirurgischer Eingriffe in den letzten Jahren beeinflusst. Im vorliegenden Beitrag werden die Standardmethoden mit Ausblick auf innovative Verfahren dargestellt. Ihre Auswahl und ihr Einsatz sollten sich streng an der S3-Leitlinie der CAADIP (Chirurgische Arbeitsgemeinschaft Adipositastherapie und metabolische Chirurgie) zur Adipositas und metabolischen Chirurgie orientieren [1].

Die zunehmende Prävalenz der morbiden Adipositas geht auch in Deutschland mit einem deutlichen Anstieg adipositas- und metabolisch-chirurgischer Eingriffe einher. Diese sind effektiv, um die klinischen und biochemischen Manifestationen des metabolischen Syndroms positiv zu beeinflussen. Es ist nicht nur die Gewichtsreduktion durch Restriktion und Hypoabsorption, sondern es sind die bisher in ihrer Komplexität nicht verstandenen neurohumoralen Mechanismen, durch die die metabolische Chirurgie verändernd eingreift. Das Verständnis neurohumoraler Mechanismen sowie neue Techniken und Innovationen haben das Spektrum adipositas- und metabolisch-chirurgischer Eingriffe in den letzten Jahren beeinflusst. Im vorliegenden Beitrag werden die Standardmethoden mit Ausblick auf innovative Verfahren dargestellt. Ihre Auswahl und ihr Einsatz sollten sich streng an der S3-Leitlinie der CAADIP (Chirurgische Arbeitsgemeinschaft Adipositastherapie und metabolische Chirurgie) zur Adipositas und metabolischen Chirurgie orientieren [1].

Bariatric surgery candidates (BSC) are a highly vulnerable group for mental health impairments. According to the theoretical model of weight stigma, weight-related experienced stigmatization (ES) negatively influences mental health through weight bias internalization (WBI). This study tested this model among BSC and investigated whether this association depends on a negative body image in terms of weight and shape concern as a potential moderator. As part of a German multicenter study, ES, WBI, weight and shape concern, and depressive symptoms were assessed via self-report questionnaires among n = 854 BSC. Simple and moderated mediation analyses were applied to analyze whether WBI influences the relationship between ES and depressive symptoms, and whether this influence depends on weight and shape concern. WBI significantly mediated the relationship between ES and depressive symptoms by partially reducing the association of ES with depressive symptoms. Weight and shape concern emerged as significant moderators in the overall model and specifically for associations between WBI and depressive symptoms. The results suggest that the association between ES and depressive symptoms among BSC is stronger in those with high WBI. This association is strengthened by weight and shape concern, especially at low and mean levels. Studies evaluating longitudinal associations between weight-related stigmatization and mental health are indicated, as well as intervention studies targeting WBI in order to reduce adverse effects of ES on mental health in BSC.

In Germany the increasing prevalence of morbid obesity is accompanied by a significant increase in number of metabolic and bariatric procedures. Metabolic and obesity surgery are effective in positively influencing clinical and biochemical manifestations of the metabolic syndrome in morbidly obese patients. Restrictive and hypoabsorptive procedures lead to a loss of excess body weight loss and amelioration of comorbidities. These changes are the result of metabolic and neurohumoral changes resulting from the surgical procedure. Neurohumoral changes are currently not completely understood. Knowledge of humoral changes and weight loss as well as new surgical techniques have influenced bariatric procedure selection. Standard procedures and selected new techniques are discussed in the following article. Indications and selection of the procedures should be strictly based on the S3 guideline on obesity and metabolic surgery from the CAADIP ("Chirurgische Arbeitsgemeinschaft Adipositastherapie und metabolische Chirurgie", [1]).

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most performed techniques in bariatric surgery. The aim of this study is to compare two surgical procedures in terms of weight loss and the development of comorbidities such as type II diabetes mellitus T2D, arterial hypertension, sleep apnea (OSAS), and gastroesophageal reflux disease (GERD). Data from the German Bariatric Surgery Registry (GBSR) from 2005 to 2021 were used. 1,392 RYGB and 1,132 SG primary surgery patients were included. Minimum age 18 years; five-year follow-up data available. Tests were performed with a 5

ZusammenfassungIn der Lehre spielen die Adipositas- und metabolische Chirurgie aktuell eine limitierte Rolle. Allerdings besteht aufgrund der rasant wachsenden Zahl an operativen Eingriffen die Notwendigkeit der Kenntnisvermittlung sowohl im Humanmedizinstudium als auch in der gastroenterologischen, allgemein- und viszeralchirurgischen Facharztausbildung.Narrative Kurzübersicht.Die Aufnahme der komplexen Lehrinhalte der Adipositas- und metabolischen Chirurgie in die chirurgische Lehre und in die allgemein- sowie viszeralchirurgische Facharztausbildung ist essenziell, um zukunftsorientiert hinsichtlich der Entwicklung des Fachgebiets gewappnet zu sein.

Zusammenfassung Ziel In dieser Arbeit werden die Resultate der Sleeve Gastrektomie (SG) von Jugendlichen und älteren Patienten verglichen. Methodik Vom 01.01.2005 bis 31.12.2020 wurden 317 Jugendliche (≤21 Jahre) im prospektiven, multizentrischen German Bariatric Surgery Registry erfasst. Ihre Daten werden mit 3721 Patienten (30–40 Jahre) gegenübergestellt. Fokus liegt auf der Veränderung von BMI, T2DM, aHTN, OSAS, GERD und perioperativen Ereignissen. Die Parameter wurden mittels Propensity-Score-Matching verglichen. Ergebnisse Ein Matching erfolgte für 273 (86,1%) Patienten. Es wurden keine signifikanten Unterschiede in der Remission von T2DM, OSAS oder GERD beobachtet. Die Remission der aHTN zeigte signifikante Vorteile zugunsten jugendlicher Patienten (p<5%). Für die perioperativen Ereignissen und BMI-Reduktion fand sich kein signifikanter Unterschied. Schlussfolgerung Die SG ist ein sicheres, wirksames Verfahren. Es führt altersunabhängig zu einer guten Gewichtsabnahme und Verbesserung der Komorbiditäten. Da die SG mit diversen Komplikationen verbunden sein kann, sollte die Indikation bei Jugendlichen von einem interdisziplinären Team gestellt werden. Die Nachsorge sollte langfristig interdisziplinär erfolgen.

PURPOSE:Sleeve gastrectomy (SG) is a common bariatric procedure that has been shown to be effective in both the short and long term, but it is not without risks, some of which necessitate revision or redo surgery (RS).MATERIALS AND METHODS:GBSR (German Bariatric Surgery Registry) data were evaluated in this multicenter analysis. Short-term results (1-year follow-up) of RS (Re-Sleeve gastrectomy, Roux-en-Y gastric bypass, RYGB, Omega-loop gastric bypass, OLGB, and duodenal switch, DS) following primary SG (n = 27939) were evaluated.RESULTS:Of PSG patients, 7.9% (n=2195) needed revision surgery. Nine hundred ninety-four patients underwent the aforementioned four surgical procedures (95 with R-SG, 665 with RYGB, 141 with OLGB, and 93 DS). Loss of follow-up within 1 year 52.44%. The most common reasons for RS were weight regain and/or a worsening of preexisting comorbidities. Regarding the operating time, R-SG was the shortest of the four procedures, and DS was the longest. In general, there were no significant advantages of one procedure over another in terms of complication incidence in these categories. However, certain complications were seen more often after R-SG and DS than with other redo procedures. There were significant differences in BMI reduction 1 year after surgery (RYGB: 5.9; DS: 10.1; OLGB: 9.1; and R-SG: 9.1; p<0.001). GERD, hypertension, and sleep apnea demonstrated statistically significant comorbidity remission. Diabetes exhibited non-significant differences.CONCLUSION:According to the findings of our study, all revision surgeries effectively resolved comorbidities, promoted weight loss, and lowered BMI. Due to the disparate outcomes obtained by various methods, this study cannot recommend a particular redo method as the gold standard. Selecting a procedure should consider the redo surgery's aims, the rationale for the revision, the patient's current state, and their medical history.

BACKGROUND:Although there is extensive literature on the effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), debate continues regarding their long-term effects on comorbidities and weight development. Therefore, both interventions continue to be the subject of scientific studies.METHODS:Weight changes, obesity-related diseases, and perioperative events are compared after both procedures. Patient data were entered into the German Bariatric Surgery Registry (GBSR). A follow-up of three years was performed. Any P value ≤0.05 indicates a significant difference.RESULTS:Seven thousand seven hundred fifty-five patients were followed for three years (SG=3791, RYGB=3964). Excess weight loss was 61.9 in SG and 69.5 in RYGB (P<0.001). BMI reduction was not significantly different (P=0.638) between the two groups. RYGB was significantly associated with remission of non-insulin-dependent diabetes mellitus (P=0.024), insulin-dependent diabetes mellitus (P=0.002), hypertension (P<0.001), sleep apnea (P<0.001) and reflux disease (GERD) (P<0.001), and a lower incidence of bleeding requiring surgical intervention (P<0.001). The SG was associated with a lower incidence of anastomotic stenosis and ileus (P=0.006 and<0.001, respectively).CONCLUSIONS:Both SG and RYGB reduce comorbidity and weight. However, RYGB is associated with a higher %EWL and remission rate of obesity-associated diseases than SG. However, it remains to be seen whether the outcomes of the two interventions are similar after a more extended follow-up period.

While obesity is prevalent among patients with type I diabetes mellitus (T1DM), the effects of metabolic surgery on patients with T1DM have not been adequately investigated. The study aims to investigate the perioperative outcomes and the improvement of comorbidity 1 year following metabolic surgery amongst this patient population. In this study, we evaluated the effects of sleeve gastrectomy (SG) and Roux-Y gastric bypass (RYGB) on patients with T1DM and insulin resistance. One hundred forty-nine patients (SG n = 91 and RYGB n = 58) with obesity, T1DM, and insulin resistance were analyzed. There was no significant difference in BMI reduction and

Background: Sex may play an essential role in predicting outcomes after bariatric surgery. This study aimed to investigate the influence of sex on short- and long-term outcomes after laparoscopic sleeve gastrectomy (LSG).Method: The primary LSG (N = 3761) was evaluated from 2005 to 2020. Data were compared between men (N = 1217) and women (N = 2544). Outcome criteria were perioperative morbidity, postoperative complications, and remission of comorbidities after a 3-year follow-up.Results: Male patients were significantly older (46.2 years vs. 43.8 years) and heavier (167.1 kg vs. 138.6 kg) than female patients. Intraoperative bleeding, postoperative bleeding requiring transfusion, and surgery occurred more frequently in men than in women (p = 0.041, p = 0.005, and p < 0.001, respectively). Operating time and length of hospital stay were longer in men than in women. Percent excess weight loss (%EWL) was 63.6 +/- 25.2 in women and 58.4 +/- 24.9 in men (p < 0.001). A significant difference in favor of women was observed in remission of hypertension (p < 0.001).Conclusions: In both sexes, LSG is effective in treating obesity. The male sex may have an adverse effect on the outcome of bariatric surgery. However, this tendency has not been clearly elucidated, and further scientific studies are needed.

INTRODUCTION:One of the most severe side effects of sleeve gastrectomy (SG) is the development or aggravation of reflux disease. This study investigates the effect of SG on the development of reflux disease and the variables that may impact this development. In addition, trends in revision surgery, weight, and comorbidity are examined among patients with reflux disease and SG and those without reflux disease and SG. This study includes 3379 individuals without reflux disease who had primary SG and were followed for three years. The demographic characteristics, comorbidities, technical features, and complications of SG were analyzed. Data were collected by the German Bariatric Surgery Registry (GBSR). 860 (25.45%) Group A patients had reflux disease following SG (Group B: no reflux after SG; 74.55%). Patients with reflux disease had longer operating times (83.8 min vs. 77.5 min, p < 0.001) and longer postoperative hospital admissions (6 days vs. 5.5 days). In group A, the %EWL was substantially greater than in group B (64.1 vs. 61.1%). 42 patients were converted from SG to RYGB (4.88%), 2 had hiatoplasty, and 5 got Endostim. There is no significant variation in perioperative complications (p value > 0.05). The incidence of complete remission of sleep apnea was higher in group A than in group B (p = 0.013; 50% vs. 44.8%). Other comorbidities were not substantially different. Reflux illness after SG is still poorly understood, despite much research. Technical and preoperative variables may promote its development. However, these assumptions remain theoretical and are not confirmed by scientific data. The majority of patients may be successfully treated using non-invasive methods, although sometimes further surgery is necessary. Despite our results and the literature, this subject is intriguing for further research.

ZUSAMMENFASSUNG Die metabolische Chirurgie ist aktuell die effektivste Therapie zur Behandlung der morbiden Adipositas und der assoziierten Begleiterkrankungen. Der Beitrag stellt die Operationsverfahren und deren Stellenwert vor.

BACKGROUND In comparison to conservative therapy, bariatric surgery has shown many reasonable results. The current study investigates whether Omega-Loop-Gastric-Bypass (OAGB) or Roux-en-Y Gastric-Bypass (RYGB) improves weight loss, comorbidities, and perioperative complications. METHODS 28,683 patients after RYGB and OAGB were included in our study. Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after one year of follow-up. RESULTS 14,253 patients had completed a one-year follow-up (13,483 patients by RYGB and 770 by OAGB). BMI reduction was a significant difference in favor of OAGB (17.5 ± 5.6 kg/m2 for OAGB vs. 15.2 ± 5.0 for RYGB; p<0.001). The %EWL was not significantly different between the two groups (p=0.073). There was also no significant difference in perioperative complications between the two groups (overall p>5%). Significant differences in favor of OAGB were observed in remission of insulin-dependent diabetes mellitus (IDDM) (p<0.001), and sleep apnea (p=0.002). Remission of reflux was more observed in RYGB than OAGB (p<0.001). Operating time was significantly higher in RYGB than OAGB (p<0.001). CONCLUSIONS Compared with RYGB, OAGB showed significant advantages in many respects. In particular, remission of comorbidities was significantly better after OAGB than in patients after RYGB during the one-year follow-up period. Nevertheless, many other factors such as medical history, long-term expected goals of bariatric surgery, and preexisting comorbidities should be taken into account when determining indications between the two procedures. Further studies with longer follow-up periods should be conducted to determine the efficacy of the two methods more accurately.

The SNP rs10487505 in the promotor region of the leptin gene was reported to be associated with decreased circulating leptin and increased body mass index (BMI). However, the phenotypic outcomes affected by rs10487505 in the leptin regulatory pathway have not been systematically studied. Therefore, the aim of this study was to elucidate the influence of rs10487505 on leptin mRNA expression and obesity-related parameters. We genotyped rs10487505 in DNA samples from 1665 patients with obesity and lean controls and measured leptin gene expression in paired samples of adipose tissue (AT, N = 310), as well as circulating leptin levels. We confirm the leptin-lowering effect of rs10487505 in women. In contrast to the previously reported data from population-based studies, in this mainly obese cohort, we describe a lower mean BMI in women carrying the C allele of rs10487505. However, no association of rs10487505 with AT leptin mRNA expression was found. Our data suggest that reduced circulating leptin levels are not a result of the direct silencing of leptin mRNA expression. Furthermore, leptin reduction by rs10487505 does not associate with BMI in a linear manner. Instead, the decreasing effect on BMI might be dependent on the severity of obesity.

In previous genome-wide association studies (GWAS), genetic loci associated with obesity and impaired fat distribution (FD) have been identified. In the present study, we elucidated the role of the PEMT gene, including the waist–hip-ratio-associated single nucleotide polymorphism rs4646404, and its influence on obesity-related metabolic traits. DNA from 2926 metabolically well-characterized subjects was used for genotyping. PEMT expression was analyzed in paired visceral (vis) and subcutaneous (sc) adipose tissue (AT) from a subset of 574 individuals. Additionally, PEMT expression was examined in vis, sc AT and liver tissue in a separate cohort of 64 patients with morbid obesity and liver disease. An in vitro Pemt knockdown was conducted in murine epididymal and inguinal adipocytes. Our findings highlight tissue-specific variations in PEMT mRNA expression across the three studied tissues. Specifically, vis PEMT mRNA levels correlated significantly with T2D and were implicated in the progression of non-alcoholic steatohepatitis (NASH), in contrast to liver tissue, where no significant associations were found. Moreover, sc PEMT expression showed significant correlations with several anthropometric- and metabolic-related parameters. The rs4646404 was associated with vis AT PEMT expression and also with diabetes-related traits. Our in vitro experiments supported the influence of PEMT on adipogenesis, emphasizing its role in AT biology. In summary, our data suggest that PEMT plays a role in regulating FD and has implications in metabolic diseases.