PURPOSE:Massive weight loss after bariatric surgery is often associated with alterations in breast morphology, including ptosis, excess skin, poor tissue elasticity, and altered nipple position, which frequently motivate requests for breast surgery. However, data on implant-based augmentation after massive weight loss are sparse and often limited to small series. This study aimed to compare surgical techniques and implant selection in post-bariatric patients versus non-bariatric women undergoing primary augmentation. METHODS:We conducted a national, population-based case-control study within the Breast Reconstruction After Bariatric Surgery protocol (NCT07059104). Patients occurring in both the Scandinavian Obesity Surgery Registry and the Swedish Breast Implant Registry were identified. A non-bariatric control group having breast augmentation was created. RESULTS:A total of 817 post-bariatric patients (1634 breasts) and 3512 controls (7023 breasts) were analysed. Surgery occurred a median of 3.4 years after bariatric surgery. Post-bariatric patients reported greater dissatisfaction with breast volume. They more often received larger implants, round shapes, and micro- or macro-textured or polyurethane surfaces. Dual-plane or submuscular placement was predominant in both groups, whereas subfascial and subglandular placements were less common in post-bariatric patients. Augmentation mastopexy was more frequent, while the use of mesh/ADM and lipofilling remained rare. Postoperative antibiotics were prescribed more often to post-bariatric patients. CONCLUSION:Breast augmentation after massive weight loss differs from standard practice, with larger and more textured implants and a higher frequency of mastopexies, highlighting surgical adaptation to complex anatomy.

Background Massive weight loss (MWL) is becoming more common, yet there is limited knowledge about the sociodemographic and clinical features of women undergoing post-mastectomy breast reconstruction following MWL. This study compared women with and without prior MWL who are undergoing breast reconstruction. Methods This nationwide, population-based case-control study used prospectively collected Swedish national registry data. Women who underwent bariatric surgery between 2007 and 2022 and subsequently received implant-based breast reconstruction after mastectomy were identified and matched by age and body mass index to controls without previous bariatric surgery, with at least three controls per patient. Sociodemographic characteristics, specialist-care diagnoses, and dispensed drugs were compared between groups. Results Eighty-one women with MWL were matched with 993 controls. Women with MWL had lost an average of 30.6 kg before reconstruction. They were more frequently separated or divorced and had lower educational attainment, although the educational difference did not remain significant after Bonferroni correction. Employment and income levels were similar between groups. Diagnoses from specialist care were generally more common among women with MWL: diabetes, cardiovascular, gastrointestinal, rheumatic, and psychiatric diseases occurred at more than twice the frequency compared to controls, although most differences were not significant after correction. Women with MWL also had higher usage of several types of drugs. Differences in dispensed vitamins and minerals and anaemia drugs remained significant after Bonferroni correction. Conclusions Women undergoing breast reconstruction after MWL form a distinct subgroup with higher medical and psychosocial complexity than women without MWL. Recognising these differences can aid patient assessment and perioperative planning.

BACKGROUND:Bariatric surgery is currently one of the most performed elective laparoscopic procedures. Continuous refinement elevates standards. OBJECTIVES:This retrospective cohort study aimed to determine aspirational benchmarks for laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) in an unselected cohort, developing adjusted reference values for groups at risk of severe complications. SETTING:Nationwide registry study including every bariatric facility in Sweden. METHODS:Using data from the Scandinavian Obesity Surgery Registry encompassing Swedish primary LRYGB and LSG procedures from 2012 to 2021, the Achievable Benchmark of Care methodology was employed to establish reference values for quality-related surgical outcomes, notably severe complications. The data included perioperative and postoperative data up to 30 days after surgery. Logistic regression identified risk factors for severe complications (Clavien-Dindo > II). Adjusted benchmarks were developed for relevant subgroups using the Achievable Benchmark of Care methodology. RESULTS:The study included 36,846 LRYGB and 15,246 LSG patients. Severe postoperative complications occurred in 3.6% (interquartile range: 2.5%-5.1%) of LRYGB cases, with a benchmark of 1.5%. Risk factors included prior deep vein thrombosis and ongoing antidepressant use. In the LSG group, 1.9% (interquartile range: .5%-3.7%) experienced severe complications, compared to a benchmark of .4%. Risk factors encompassed age, body mass index, smoking, dyspepsia, and diabetes. Only diabetes in the LSG group increased the benchmark to 1.2% for severe complications. CONCLUSIONS:These benchmarks, developed from validated national registry data, are more demanding than previous global benchmarks. They prompt reflection on surgical quality and will hopefully inspire further quality improvement initiatives across bariatric surgery providers.

Abstract Introduction Ventral incisional hernia is a known complication following bariatric surgery. A 3% cumulative incidence of ventral hernia surgery five years after bariatric surgery was previously published, showing a higher risk for Roux-en-Y gastric bypass (LRYGB) compared to sleeve gastrectomy (LSG). This risk factor analysis aims to identify predictors of ventral hernia surgery following bariatric surgery in the same cohort, and to determine wether the observed difference between surgical methods persists after adjustment for additional covariates. Methods This registry-based cohort includes all patients undergoing primary laparoscopic LRYGB or LSG in Sweden 2009–2019, and links data from the Scandinavian Obesity Surgery Registry (SOReg) to the Swedish Patient Register. Primary endpoint was ventral hernia surgery within five years. Cox proportional hazard models were fitted to examine associations between the outcome and baseline factors, extended with pre-, peri- and postoperative factors. Results Higher age and BMI were associated with increased risk of ventral hernia surgery within five years after bariatric surgery. Previous cholecystectomy was associated with higher risk (HR 1.4), as was prior ventral hernia diagnosis (HR 20.6). Longer operative time and concurrent surgery were independent risk factors (HR 1.1 per 30-min increase, and HR 2.0). Non-minor surgery within 30 days increased the risk (HR 3.8). LRYGB demonstrated a persistently higher hazard (HR 1.6) compared to LSG. Discussion Patient factors, perioperative factors and previous- and later abdominal surgery can be identified as risk factors for ventral hernia surgery five years after bariatric surgery. The risk for LRYGB remains higher compared to LSG after adjusting for additional factors.

BackgroundCore outcome sets are an established method for standardising the collection, measurement and reporting of treatment outcomes in effectiveness trials. Using Delphi survey methodology, core sets are developed by prioritising and re-prioritising data items facilitated by provision of feedback of other stakeholders' responses. It is unknown how best to provide feedback to ensure that it influences the re-prioritisation of items effectively. This study examined whether informing participants of the top-rated items from the previous survey round may influence the re-prioritisation of data items in a subsequent survey round during the development of core data sets.MethodsThis study was nested in the development of a registry core data set. In round two of the Delphi survey, participants were randomised to receive 'standard' or 'enhanced' instructions. 'Enhanced' instructions included summarised data of the top five data items scored by participants in the previous survey round) in addition to standard feedback (the median round 1 score per item). Items scored 7-9 by ≥70% of participants in round 2 were considered 'prioritised'. Concordant/discordant items were determined and extent of agreement between groups calculated (kappa statistics).ResultsBoth groups prioritised a larger number of items in round 2 than in round 1 and there was little difference in the percentage of respondents prioritising the 'Top 5' items in round 2 (mean change in prioritisation of Top 5 items for all four core sets combined - 2.3% increase in standard group and 3.2% increase in enhanced group). Overall agreement in data items prioritised by both groups improved in round 2 (discordant items - 11% in round 1 and 4% in round 2).ConclusionProviding participants with additional feedback during the process of item prioritisation did not promote prioritisation of items during development of a core set. In the development of health core sets, where often many items are prioritised, further work to determine how to clearly and optimally communicatee feedback in a manner that promotes consensus effectively is required. Specifically, qualitative work with relevant stakeholders, exploring and clarifying the concepts of prioritisation and consensus, is warranted.

BACKGROUND/OBJECTIVES:Studies show equal or better resolution of type 2 diabetes mellitus (T2D) and other metabolic outcomes after Roux-en-Y gastric bypass (RYGB) compared to sleeve gastrectomy (SG), but it is unclear whether this is related only to the higher weight loss after RYGB, or if there are weight-loss-independent factors. The objective of this study was to examine weight-loss-independent differences in metabolic outcomes between RYGB and SG. METHODS:This study utilized the Scandinavian Obesity Surgery Registry and the Swedish National Diabetes Register. All included patients had presurgical T2D and matching was between RYGB or SG using a 1:1 propensity score, matching with a generalized linear model including age, sex, BMI at baseline, comorbidities (cardiovascular, dyslipidemia, sleep apnea, and hypertension), T2D parameters at baseline (HbA1c, number of T2D medications, insulin use, duration of T2D), year of surgery and percentage Total Weight Loss (%TWL) at nadir. The ensuing cohort was compared regarding remission and improvements in T2D, and other cardiometabolic outcomes, including major adverse cardiovascular events (MACE). RESULTS:1440 individuals (720 RYGB; 720 SG) were matched 1:1 using Propensity score. There were 494 (68.6%) patients in complete T2D remission at 2 years after RYGB, and 438 (60.8%) after SG, (OR: 0.75, 95% CI 0.60 - 0.93, p = 0.010) despite similar TWL (Standardized mean difference 0.12). SG also had a lower rate of pharmacological remission for T2D (OR 0.71, 95% CI 0.56-0.88, p = 0.002), and hypertension remission (OR 0.70, 95% CI 0.52-0.94, p = 0.019), but there was no significant difference in pharmacological remission regarding dyslipidemia (OR 0.83, 95%CI 0.66-01.04, p = 0.11). No difference was seen in the risk for MACE (SG vs. RYGB HR:1.45, 95%CI 0.89-2.38, p = 0.136). CONCLUSIONS:RYGB is associated with a greater rate of T2D remission compared to SG. This study suggests that these improved outcomes are independent of the degree of weight loss.

PURPOSE:Breast augmentation after massive weight loss (MWL) is surgically challenging owing to altered anatomy and tissue quality. Previous case series suggest higher revision rates, but controlled, population-based evidence is lacking. We aimed to evaluate long-term outcomes, including reoperation frequency and indications, after primary augmentation in MWL patients compared with matched controls. METHODS:We performed a nationwide, population-based case-control study using prospectively collected registry data (SOReg and BRIMP). The cohort comprised 817 MWL patients undergoing 1634 primary augmentations and 3512 matched controls with 7023 procedures (2004-2022). Follow-up averaged 5.4 (SD 2.9) and 5.6 (SD 2.8) years, respectively. Revision procedures, indications for re-operations, and intraoperative findings were analyzed. Statistical comparisons employed the Mann-Whitney U and Fisher's exact tests with Bonferroni-Holm correction. RESULTS:Reoperation was more frequent in MWL patients (9.4% vs. 7.1%, p<0.001), with shorter time to first revision (1.5 (SD 1.8) vs. 2.3 (SD 2.4) years, p<0.001). Implant malposition (20% vs. 11%, p=0.004), rotation (9.5% vs. 3.1%, p=0.002), and seroma (6.9% vs. 1.7%, p=0.002) were more common in MWL revisions. Indications were similar, most often patient-driven changes. CONCLUSION:Breast augmentation after MWL carries a higher and earlier risk of reoperation compared with the controls, though absolute complication rates remain low. These findings provide population-based evidence to guide patient counseling and surgical planning in this complex group.

Purpose Breast augmentation after massive weight loss (MWL) is surgically challenging due to altered anatomy and tissue quality. Previous case series suggest higher revision rates, but controlled, population-based evidence is lacking. This study aimed to evaluate long-term outcomes, including reoperation frequency and indications, after primary augmentation in MWL patients compared with matched controls. Methods We performed a nationwide, population-based case-control study using prospectively collected registry data (SOReg, BRIMP). The cohort comprised 817 MWL patients undergoing 1,634 primary augmentations and 3,512 matched controls with 7,023 procedures (2004–2022). Follow-up averaged 5.4 (SD 2.9) and 5.6 years (SD 2.8), respectively. Revision procedures, indications for re-operations, and intraoperative findings were analysed. Statistical comparisons employed Mann-Whitney U and Fisher’s exact tests with Bonferroni-Holm correction. Results Reoperation was more frequent in MWL patients (9.4% vs. 7.1%, p<0.001), with shorter time to first revision (1.5 (SD 1.8) vs. 2.3 years (SD 2.4), p<0.001). Implant malposition (20% vs. 11%, p=0.004), rotation (9.5% vs. 3.1%, p=0.002), and seroma (6.9% vs. 1.7%, p=0.002) were more common in MWL revisions. Indications were similar, most often patient-driven changes. Conclusion Breast augmentation after MWL carries a higher and earlier risk of reoperation compared with controls, though absolute complication rates remain low. These findings provide population-based evidence to guide patient counselling and surgical planning in this complex group.

BACKGROUND:Bariatric surgery increases the risk of anemia, but long-term data from large cohorts are sparse, and it is unclear if certain groups are at a higher risk. OBJECTIVES:Define factors associated with anemia at 5 years of follow-up after bariatric surgery. SETTING:Data from a national quality register. METHODS:This cross-sectional study uses Scandinavian Obesity Surgery Registry data on primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures in Sweden from 2007 to 2020. Hemoglobin and ferritin were analyzed preoperatively and up to 10 years postoperatively. Factors associated with anemia were evaluated using hemoglobin and ferritin samples 5 years postsurgery. RESULTS:The study included 73,612 patients (RYGB: 80.7%, SG: 19.3%). Hemoglobin and/or ferritin data were available for 18,993 patients 5 years postsurgery, of whom 3508 patients (18.5%) had anemia and 691 patients (27.0%) subnormal ferritin levels. Anemia and subnormal ferritin were more prevalent after RYGB than SG (19.6% versus 11.3%, adjusted odds ratio [aOR] = .58 and 24.1% versus 15.6%, aOR = .43). Females had a higher prevalence of anemia than males (20.6% versus 11.1%, aOR = .50). Young age was associated with a higher risk of anemia (31.0%), as was large postoperative weight loss (highest quartile 25.2%). Results regarding iron supplementation were not conclusive. CONCLUSIONS:The prevalence of anemia, likely secondary to iron deficiency, increases up to 10 years post bariatric surgery. Female sex, young age at surgery, large weight loss, and undergoing RYGB were associated with an increased risk of anemia, indicating a need for targeted strategies for vitamin and mineral supplementation in these groups.

Introduction:Risk stratification is essential when selecting the timing and technique of breast reconstruction. While several prediction models exist, none have incorporated prior massive weight loss (MWL), despite a growing population of such patients. This study aimed to develop cumulative risk prediction models for complications after implant-based breast reconstruction, explicitly including MWL as a candidate predictor. Methods:This nationwide, population-based case-control study used prospectively collected Swedish registry data. Patients with prior bariatric surgery who underwent immediate or delayed post-mastectomy implant-based breast reconstruction between 2007 and 2022 were identified and matched to at least 3 controls by age and body mass index. Candidate predictors were selected based on prior literature. Group least absolute shrinkage and selection operator (LASSO) regression with bootstrap resampling was used to develop prediction models, which were visualized as nomograms. Results:A total of 245 immediate and 602 delayed breast reconstructions were included; 11% and 6%, respectively, had a history of MWL. Complication rates were 16.3% for immediate and 14.5% for delayed reconstruction. Prior MWL was consistently selected as an independent predictor of complications in both immediate and delayed reconstruction models and of re-admission after delayed reconstruction. Other predictors included age, body mass index, radiotherapy, comorbidity-related medications, and antibiotic use. Conclusion:Prior massive weight loss following bariatric surgery is an independent risk factor for complications after both immediate and delayed implant-based breast reconstruction. Incorporating MWL into cumulative risk prediction models improves individualized risk assessment and supports informed, shared decision-making in reconstructive breast surgery.

BACKGROUND:Obesity is increasing among patients with inflammatory bowel disease, but bariatric surgery has been rare in this group owing to concerns about worsening the inflammatory bowel disease. The aim of the study was to evaluate inflammatory bowel disease-related outcomes following bariatric surgery. METHODS:Nationwide cohort of all adult patients in Sweden between 2007 and 2020 with obesity and inflammatory bowel disease. Patients were matched 1 : 1 with a two-stage matching process between those undergoing bariatric surgery with those who did not (classified by inflammatory bowel disease subtype followed by a propensity score match including sex, age, number of previous targeted therapies, presence of immunotherapy, cumulative oral corticosteroid dose, and previous intestinal surgery). The primary composite outcome comprised inflammatory bowel disease-related hospitalization, initiation of corticosteroid therapy, immunomodulation, commencement of a new targeted therapy or major inflammatory bowel disease-related surgery. RESULTS:The study included 798 patients with inflammatory bowel disease and obesity: 399 who underwent bariatric surgery (145 Crohn's disease, 238 ulcerative colitis, 16 unclassified inflammatory bowel disease) versus 399 who did not. Over a median observation period of 3.3 years in the surgery group and 3.0 years in the non-surgery group, the composite primary endpoint occurred in 201 patients who had surgery (incidence rate 11.9 (95% confidence interval (c.i.) 10.2 to 13.5) per 100 person-years) and 226 without surgery (incidence rate 15.1 (13.1 to 17.0) per 100 person-years), corresponding to an adjusted hazard ratio of 0.66 (95% c.i. 0.51 to 0.85) in those undergoing bariatric surgery compared with those who did not. CONCLUSION:Bariatric surgery was associated with improved inflammatory bowel disease-related outcomes among patients with inflammatory bowel disease and obesity, suggesting a potential benefit from bariatric surgery among patients with concomitant obesity and inflammatory bowel disease.

Background:Long-term data on the efficacy and safety of Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in people with type 2 diabetes mellitus (T2DM) are still limited. Using a matched cohort design, we aimed to evaluate the long-term effects of RYGB and SG on individuals with T2DM, focussing on obesity- and surgery-related outcomes over a follow-up period of up to 14 years. Methods:A nationwide, matched, longitudinal study was conducted using data from the Swedish National Diabetes Register (NDR) and the Swedish Obesity Surgery Registry (SOReg). Between 2007 and 2020, all individuals with T2DM who underwent primary surgery (RYGB = 7294 and SG = 1105) were identified through SOReg and matched by age, sex, and BMI to a control group of individuals with T2DM from NDR who had not undergone surgery (n = 8399). Data on all-cause mortality and obesity- and surgery-related outcomes after RYGB and SG were retrieved from national registers with almost complete coverage. Risks were expressed as incidence rates per 10,000 person-years and analysed using adjusted Cox regression models, which included duration of diabetes, yielding adjusted hazard ratios (HR) with 95% confidence intervals (CI). Findings:During follow-up, the percentage total weight loss and reductions in HbA1c levels were significantly greater after RYGB and SG than in unexposed individuals (%TWL: RYGB 23·2 vs. 3·6 and SG 17·1 vs. 3·1 at two years, smd > 0·1) and (mean HbA1c: RYGB 46 (SD 14) vs. 58 (SD 17) and SG 46 (SD 13) vs. 55 (SD 15) at two years, smd > 0·1). RYGB was associated with sustainable reductions in all-cause mortality (adjusted HR of 0·62 (95% CI [0·51-0·71])) and obesity-related comorbidities, with risks as much as 45% lower compared to unexposed individuals (p < 0·001). However, individuals after RYGB face as much as a twofold increased risk of malabsorption and micronutrient deficiency (adjusted HR of 2·00 (95% CI [1·76-2·28])) and alcohol use disorder (adjusted HR of 2·82 (95% CI [2·37-3·36])), p < 0·001. The risk of other psychiatric disorders, such as depression (adjusted HR of 1·28 (95% CI [1·14-1·43])), and surgical complications, such as bowel obstruction (adjusted HR of 3·96 (95% CI [3·15-4·98])), was also higher after RYGB (p < 0·001). In contrast, the SG cohort showed no significant effects on obesity-related conditions and risk of surgical complications, despite similar weight reduction in both surgery groups. Interpretation:The study highlights the advantages and limitations of RYGB and SG, providing insights to guide an individualised approach. The limited efficacy of SG in lowering obesity-related disease risks should be a key consideration when selecting individuals with T2DM for surgery. Funding:A grant from the Swedish state under the agreement with the county councils.

BACKGROUND:The Swiss-Finnish Bariatric Metabolic Outcome Score (SF-BARI Score), based on merged data of two RCTs, is a composite endpoint designed to evaluate and categorize outcomes after metabolic bariatric surgery (MBS). The aim of this study was to externally validate the score using registry data. METHODS:Individual patient data were included from the Dutch Audit for Treatment of Obesity, the Scandinavian Obesity Surgery Registries (SOReg-Sweden and SOReg-Norway), and the merged RCT data used for establishing the SF-BARI Score. All patients undergoing primary MBS from January 2010 to June 2018, with complete baseline characteristics, as well as complete 1- and 5-year follow-up data, were included. The mean total score and distribution were compared between the combined registry and merged RCT data. RESULTS:There was no statistically significant difference in the mean SF-BARI Score between the registries (21 603 patients) and merged RCTs (457 patients) at 5 years (90.9 versus 89.1 points; difference = 1.8 (95% c.i. -1.0 to 4.7); P = 0.212), and the score distribution was similar. Statistically significant differences in baseline characteristics existed regarding sex (male 20.9% versus 29.3%), type 2 diabetes (16.7% versus 33.9%), hypertension (30.4% versus 66.1%), dyslipidaemia (13.7% versus 46.5%), obstructive sleep apnoea syndrome (12.0% versus 17.4%), and sleeve gastrectomy (SG) rate (21.0% versus 49.9%) (P < 0.001). The mean score estimate at 5 years in Roux-en-Y gastric bypass was 11.2 (95% c.i. 10.2 to 12.2) points higher compared with SG (P < 0.001). CONCLUSION:This study verified the feasibility of the SF-BARI Score, enabling standardized reporting and allowing for comparison of different treatment modalities.

BACKGROUND:Obesity is a growing global health problem, and bariatric surgery is an effective treatment for severe obesity. However, massive weight loss frequently results in excess skin and altered breast morphology, resulting in some women seeking implant-based breast surgery. Evidence on the frequency and characteristics of post-bariatric women undergoing breast implant surgery is scarce, with only small case series published. We investigated the prevalence and demographics of such women compared with non-post-bariatric controls. METHODS:This national population-based case-control study used and linked data from Swedish registries. Women who underwent bariatric surgery (2008-2022) and subsequent benign implant surgery (after 2014) were identified and matched with non-bariatric controls who underwent breast augmentation by age and body mass index. Demographics, comorbidities, and drug data were analyzed and compared between the groups. RESULTS:Between 2014 and 2024, 817 post-bariatric women underwent breast implant surgery and were compared with 3512 matched controls. The frequency of implant surgery among women with previous bariatric surgery (2008-2013) was 2.8%. Post-bariatric women were more often divorced/separated, had lower education levels, and were more likely to have undergone previous breast or plastic surgery than the controls. They also had higher rates of psychiatric, endocrine, and gastrointestinal comorbidities, reflected in specialist care and prescription data. CONCLUSION:Post-bariatric women undergoing breast implant surgery constitute a distinct, medically more complex subgroup compared to non-post-bariatric implant patients. Their higher psychosocial vulnerability and comorbidity burden highlight the need for tailored clinical assessment, long-term support, and broader discussion on healthcare access for post-bariatric reconstruction. PRE-REGISTRATION:Clinicaltrials.gov NCT07059104.

This study is part of an initiative to improve the FAIRness (Findability, Accessibility, Interoperability, Reusability) of metabolic bariatric surgery (MBS) registries globally. It explores the extent to which European registry data can be manually integrated without first making them FAIR and assesses these registries’ current level of FAIRness. The findings establish a baseline for evaluation and provide recommendations to enhance MBS data management practices. Data dictionaries from five national MBS registries in Germany, France, the Netherlands, the UK, and a combined registry for Scandinavia (Norway and Sweden) were evaluated regarding their ability to manually integrate registry datasets with one another. The FAIR Data Maturity Model from the Research Data Alliance (RDA) FAIR Data Maturity Model Working Group was used to assess the FAIRness of both metadata and data of the registries. The registries showed significant variability in variables and coding structures, with inconsistent numerical formats and without linkage to international standards such as SNOMED CT, LOINC, or NCIt, making data integration labor-intensive and assumption-heavy. Despite the presence of data dictionaries, all registries failed the FAIR assessment because machine-readable data was unavailable, and only human-readable metadata was available in the form of data dictionaries in a spreadsheet. Our study reveals significant inconsistencies in data structuring and a failure to comply with the FAIR Principles, which limit effective data analysis and comparison. This emphasizes the critical need for standardized data management practices. We recommend four next steps to improve the FAIRness of MBS registries: (1) annotate data elements using standardized terminology systems, (2) deposit registry-level metadata in a repository, (3) request globally unique and persistent identifiers for datasets, and (4) define access restrictions.

The incidence of trocar site hernia (TSH) after bariatric surgery is unclear. This study aims to describe the cumulative incidence of ventral hernia surgery after laparoscopic bariatric surgery in total and by laparoscopic method (LRYGB; Roux-en-Y Gastric Bypass and LSG; Sleeve Gastrectomy). This was a register based observational study on patients subjected to laparoscopic bariatric surgery (LRYGB or LSG) in Sweden 2009–2019. The Scandinavian Obesity Surgery Registry (SOReg) was linked to the Swedish National Patient Register (NPR) to obtain instances of ventral hernia surgery. Nearby codes were used as proxies for TSH surgery, since a specific procedure code for TSH surgery is lacking. In 64 124 patients, mean follow-up was 67 ± 36 months, LRYGB (n = 52 020) 74 ± 34 months and LSG (n = 12 104) 34 ± 22 months. Mean time between bariatric- and ventral hernia surgery was 36 ± 28 months (range 0–129). The five-year cumulative incidence of surgery for ventral hernia was 2.9

BACKGROUND:Weight changes after Roux-en-Y gastric bypass (RYGB) follow different trajectories, but the effects of different trajectories on death and cardiovascular events are largely unknown. The aim of the current study was therefore to evaluate the effects of weight changes after RYGB on cardiovascular events and mortality rate. METHODS:This cohort study included patients who underwent primary RYGB in Sweden from 2007 to 2018 with a complete registration of weight at baseline, at nadir weight loss and 5-year follow-up (n = 25 230) with a mean BMI of 42.1 ± 5.2 kg/m2, age 42.5 ± 11.2 years, and 19 420 (77%) women. Patients were stratified based on weight change from nadir weight loss. The main outcome measures were major cardiovascular event (MACE) or death. RESULTS:Over a mean follow-up of 10.6 years, 1276 patients experienced at least one episode of a MACE, and 707 died. An increased risk for death and MACE was seen in patients with continued weight loss after nadir (adjusted HR compared to recurrent weight gain of 0-20% of weight lost at nadir among patients who initially lost 20-35% total weight (TWL): 1.80 (1.41-2.31) and 1.62 (1.35-1.94) respectively), and for patients who experienced >50% recurrent weight gain from nadir (adjusted HR compared to patients with recurrent weight gained 0-20% TWL: 1.61 (1.07-2.43) and 1.48 (1.09-2.00) respectively). CONCLUSION:Continued weight loss and significant recurrent weight gain after the initial weight nadir were both associated with a higher risk for MACE and death after RYGB. These should be considered non-desirable weight trajectories requiring further clinical evaluation and increased support.

Background Laparoscopic sleeve gastrectomy (LSG) has gained increasing popularity worldwide, yet concerns persist regarding the development of gastroesophageal reflux disease (GERD) postoperatively. Objectives This study aimed to evaluate the influence of technical aspects of LSG, specifically bougie size and distance from the pylorus to resection line edge, on the risk of developing symptomatic GERD within 2years following surgery. Setting Data from the Scandinavian Obesity Surgery Registry (SOReg) and the National Prescribed Drug Register were utilized for this analysis. Methods A retrospective observational study was conducted encompassing all LSG patients in Sweden between 2012 and 2020 who did not receive preoperative proton pump inhibitor (PPI) prescriptions. Patients were categorized based on bougie size and pyloric distance. Regular PPI use, defined as a dispensed prescription of more than 300 tablets per year, was employed as a proxy measure of symptomatic GERD and was compared between the groups. Results The study included 7,435 patients with complete data on dispensed PPI prescription both preoperatively and throughout the 2-year follow-up period. Information on bougie size and pyloric distance was available for 97.4% and 84.9%, respectively. Narrower bougie size and greater pyloric distance were associated with increased risk of regular PPI use postsurgery. Advanced age and female sex were independent risk factors for post-LSG regular PPI use, while initial body mass index (BMI), total weight loss (%TWL), and comorbidities showed no significant associations. Conclusions Using a narrow bougie and initiating resection at a greater distance from the pylorus were associated with higher risk of symptomatic de novo GERD following LSG.

Background Patients with initial body mass index > 50 kg/m(2) are vastly under-represented in randomized clinical trials demonstrating similar weight loss and diabetes remission rates after sleeve gastrectomy and Roux-en-Y gastric bypass. Methods Propensity score matching 1 : 1 was used to compare outcomes regarding weight loss and diabetes control after sleeve gastrectomy and Roux-en-Y gastric bypass in patients with body mass index > 50 kg/m(2) between 2012 and 2022 in a cohort from 13 centres in six European countries. The primary endpoint was percentage total bodyweight loss; secondary endpoints were diabetes remission rate and rate of persistent body mass index > 40 kg/m(2). Results In total, 3976 of 8160 patients were matched and included in the analysis (1988 in each group). Median age at baseline was 40.0 (range 16-76) years in the sleeve gastrectomy group and 39.5 (15-71) years in the Roux-en-Y gastric bypass group. Median body mass index at baseline was 56.2 (range 50.0-100.0) and 54.3 (50.0-83.9) kg/m(2), respectively (P < 0.001). The follow-up rate was 70.5% at 1 year and 24.4% at 5 years. Percentage total bodyweight loss at 1 and 5 years after sleeve gastrectomy was 30.2 (2.2-63.7) and 25.4 (-4.8 to 56.0)%, respectively, versus 31.2 (7.4-54.5) and 28.2 (-6.6 to 62.9)% in the Roux-en-Y gastric bypass group (P < 0.001 between groups in both time points). The prevalence of persistent body mass index > 40 kg/m(2) after 1 and 5 years was 42.7 and 57.6%, respectively, after sleeve gastrectomy versus 24.5 and 39.2% after Roux-en-Y gastric bypass (P < 0.001 between groups in both time points). A 5-year follow-up, the prevalence of a pathological haemoglobin A1c level (> 6.5%) was 12.9% after sleeve gastrectomy and 11.6% after Roux-en-Y gastric bypass (P = 0.323). Conclusion This study suggests that Roux-en-Y gastric bypass results in greater weight loss than sleeve gastrectomy in patients with body mass index > 50 kg/m(2), whereas improvements in diabetes appear comparable between procedures.