INTRODUCTION:Type 2 diabetes mellitus (T2DM), a chronic metabolic disease, affects millions of people worldwide, causes numerous complications, (eg, cardiovascular disease, kidney damage, neuropathy), and is strongly associated with obesity, a primary risk factor for its development and progression. In this paper, we presented 10-year outcomes of patients with T2DM who underwent metabolic and bariatric surgery (MBS), focusing on factors contributing to T2DM remission. AIM:This 10-year study evaluated MBS efficacy, focusing on T2DM remission predictors and complications. MATERIALS AND METHODS:We analyzed data of 113 patients with T2DM who underwent primary MBS between 2008 and 2014. Individuals with missing / inconsistent data or follow-up shorter than10 years were excluded. Information on surgery and treatment outcomes (described via standardized reporting) was analyzed. RESULTS:The most frequently performed surgery was sleeve gastrectomy (57.5%). Among the analyzed cohort, 10 years postsurgery, 80 patients (70.8%) experienced T2DM remission, 19 (16.8%) T2DM improvement, and 14 (12.4%) had no T2DM-related changes. Median (interquartile range) follow-up was 10.9 (10.4-11.7) years. Multivariable logistic regression showed that T2DM duration of over 10 years was associated with lower likelihood of T2DM remission, whereas the type of surgery was not a significant factor influencing it. However, undergoing one anastomosis gastric bypass (OAGB) tended to increase the probability of T2DM remission. CONCLUSIONS:Although T2DM duration remains a significant predictor of remission, the study suggests a potential trend toward higher remission rates after OAGB, which requires confirmation in larger studies.

This document presents a comprehensive update to the Polish national recommendations on metabolic and bariatric surgery, developed by a panel of experts based on the latest clinical and scientific evidence. In light of a nearly 500% increase in the number of bariatric procedures in Poland since 2014 and significant technological advancements, it became necessary to revise national guidelines in line with international standards set by the International Federation for the Surgery of Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery. A pivotal development in Poland was the implementation of the Comprehensive Specialist Care in Bariatrics (KOS‑BAR) program in 2021, which ensured more accessible and safer care for patients with severe obesity through a structured and multidisciplinary approach. The consensus covers the full scope of care: from the epidemiology of obesity, surgical eligibility criteria, and preoperative preparation, to the choice of surgical technique, postoperative care, management of complications, and revisional procedures. The document also includes guidance on pharmacological treatment as an addition or alternative to surgery, and addresses the needs of specific patient groups, such as pediatric patients, elderly individuals, women of reproductive age, and those with comorbid conditions. The aim of this update is to provide Polish patients with access to safe, effective, and evidence‑based treatment for obesity, while also aligning the health care system with the growing public health challenge posed by the obesity epidemic.

Metabolic bariatric surgery (MBS) is an effective treatment for obesity and obesity-related diseases, but long-term data on its outcomes remain limited, particularly in Poland. These data are crucial for understanding the durability of weight loss, trends in weight regain, and comorbidity remission, as well as for refining surgical techniques and improving long-term care. This study aims to evaluate the 10-year outcomes of MBS in Poland, focusing on weight loss and remission of obesity-related diseases in patients who completed follow-up. This multicenter retrospective study, named BARI-10-POL, analyzed 485 patients (mean age: 41.0 years, 71.5

Background: Although bariatric surgery in patients over 65 years of age gives comparable results to treatment in the younger population, there are still controversies regarding the indications for surgery, risk assessment and choice between different types of surgery. The study aimed to identify the factors contributing to weight loss success after bariatric surgery in patients over 65 years of age. Material and methods: This is a retrospective, multicenter cohort study of patients with obesity aged over 65 years undergoing primary laparoscopic bariatric surgery in the years 2008-2022. Data came from 11 bariatric centers. Patients were divided into two groups: responders (R) who achieved more than 50% EWL and non-responders (NR) who achieved less than 50% EWL. Both groups were compared. Uni- and multivariate logistic regression was used to identify predictors of weight loss success. Results: Out of 274 analyzed patients, the average BMI before surgery was 42.9 kg/m2. The most common obesity-related diseases were hypertension (85.1%) and type 2 diabetes (53.3%). Sleeve gastrectomy was the most frequently performed procedure (85.4%). Uni- and multivariate logistic regression analysis confirmed preoperative BMI (OR=0.9, 95%CI:0.82-0.98, P =0.02), duration of diabetes >10 years (OR=0.3, 95%CI:0.09-0.82, P =0.02), balloon placement (OR=10.6, 95%CI: 1.33-84.83, P =0.03), time since first visit (OR=0.9, 95%CI:0.84-0.99, P =0.04), preoperative weight loss (OR=0.9, 95%CI:0.86-0.98, P =0.01) and OAGB (OR=15.7, 95%CI:1.71-143.99, P =0.02) to have a significant impact on weight loss success 1 year after bariatric surgery. Conclusions: Patients with higher preoperative weight loss may have a poorer response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. Intragastric balloon placement before surgery may be effective in patients above 65 years of age and may be considered as a two-stage approach.

Introduction: Over the past three decades, almost every type of abdominal surgery has been performed and re-fined using the laparoscopic technique. Surgeons are applying it for more procedures, which not so long ago were performed only in the classical way. The position of laparoscopic surgery is therefore well established, and in many operations it is currently the recommended and dominant method. Aim: The aim of the preparation of these guidelines was to concisely summarize the current knowledge on laparos-copy in acute abdominal diseases for the purposes of the continuous training of surgeons and to create a reference for opinions. Material and methods: The development of these recommendations is based on a review of the available literature from the PubMed, Medline, EMBASE and Cochrane Library databases from 1985 to 2022, with particular emphasis on systematic reviews and clinical recommendations of recognized scientific societies. Recommendations were for-mulated in a directive form and evaluated by a group of experts using the Delphi method. Results and conclusions: There are 63 recommendations divided into 12 sections: diagnostic laparoscopy, perforat-ed ulcer, acute pancreatitis, incarcerated hernia, acute cholecystitis, acute appendicitis, acute mesenteric ischemia, abdominal trauma, bowel obstruction, diverticulitis, laparoscopy in pregnancy, and postoperative complications re-quiring emergency surgery. Each recommendation was supported by scientific evidence and supplemented with expert comments. The guidelines were created on the initiative of the Videosurgery Chapter of the Association of Polish Surgeons and are recommended by the national consultant in the field of general surgery. The first part of the guidelines covers 5 sections and the following challenges for surgical practice: diagnostic laparoscopy, perforated ulcer, acute pancreatitis, incarcerated hernia and acute cholecystitis. Contraindications for laparoscopy and the ERAS program are discussed.

Background: Bariatric surgery has relatively low complication rates, especially severe postoperative complications (defined by Clavien-Dindo classification as types 3 and 4), but these rates cannot be ignored. In other than bariatric surgical disciplines, complications affect not only short-term but also long-term results. In the field of bariatric surgery, this topic has not been extensively studied. Objectives: The aim of the study was to assess the outcomes of bariatric treatment in patients with obesity and severe postoperative complications in comparison to patients with a noneventful perioperative course. Setting: Six surgical units at Polish public hospitals. Methods: We performed a multicenter propensity score matched analysis of 206 patients from 6 Polish surgical units and assessed the outcomes of bariatric procedures. A total of 103 patients with severe postoperative complications (70 laparoscopic sleeve gastrectomy [SG] and 33 with laparoscopic Roux en Y gastric bypass [RYGB]) were compared to 103 patients with no severe complications in terms of peri-and postoperative outcomes. Results: The outcomes of bariatric treatment did not differ between compared groups. Median percentage of total weight loss 12 months after the surgery was 28.8% in the group with complications and 27.9% in patients with no severe complications (P = 0.993). Remission rates of both type 2 diabetes mellitus and arterial hypertension showed no significant difference between SG and RYGB (36% versus 42%, P = 0.927, and 41% versus 46%, P = 0.575. respectively). Conclusions: The study suggests that severe postoperative complications had no significant influence either on weight loss effects or obesity-related diseases remission. (C) 2021 Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery.

Introduction: Revisional surgery is more technically challenging and associated with increased morbidity and mortality. Nevertheless, the frequency of revisional bariatric surgery (RBS) is increasing. Therefore, investigating this group of patients appears to be currently valid. Aim: The objective of this multicenter study was to collect, systematize and present the available data on RBS after surgical treatment of morbid obesity among Polish patients. Material and methods: This multicenter study included a retrospective analysis of a prospectively maintained database. Outcomes included an analysis of the indications for RBS, the type of surgery most frequently chosen as RBS and the course of the perioperative period of treatment among patients undergoing RBS. Results: The group consisted of 799 patients (624 (78.1%) women, 175 (21.9%) men). The mean age was 38.96 +/- 9.72 years. Recurrence of obesity was the most common indication for RBS. The most frequently performed RBS procedures were one anastomosis gastric bypass (OAGB) - 294 (36.8%) patients, Roux-en-Y gastric bypass (RYGB) - 289 (36.17%) patients and sleeve gastrectomy (SG) - 172 (21.52%) patients. After primary surgery 63.58% of patients achieved sufficient weight loss, but after RBS only 38.87%. Complications were noted in 222 (27.78%) cases after RBS with GERD being the most common - 117 (14.64%) patients. Conclusions: RBS most often concerns patients after SG. The main indication for RBS is weight regain. OAGB and RYGB were the two most frequently chosen types of RBS. Secondary operations lead to further weight reduction. However, RBS are associated with a significant risk of complications.

The increasing prevalence of bariatric surgery has resulted in a rise in the number of redo procedures as well. While redo bariatric surgery has demonstrated its effectiveness, there is still a subset of patients who may not derive any benefits from it. This poses a significant challenge for bariatric surgeons, especially when there is a lack of clear guidelines. The primary objective of this study is to evaluate the outcomes of patients who underwent Re-Redo bariatric surgery. We conducted a retrospective cohort study on a group of 799 patients who underwent redo bariatric surgery between 2010 and 2020. Among these patients, 20 individuals underwent a second elective redo bariatric surgery (Re-Redo) because of weight regain (15 patients) or insufficient weight loss, i.e. < 50% EWL (5 patients). Mean BMI before Re-Redo surgery was 38.8 ± 4.9 kg/m2. Mean age was 44.4 ± 11.5 years old. The mean %TWL before and after Re-Redo was 17.4 ± 12.4% and %EBMIL was 51.6 ± 35.9%. 13/20 patients (65%) achieved > 50% EWL. The mean final %TWL was 34.2 ± 11.1% and final %EBMIL was 72.1 ± 20.8%. The mean BMI after treatment was 31.9 ± 5.3 kg/m2. Complications occurred in 3 of 20 patients (15%), with no reported mortality or need for another surgical intervention. The mean follow-up after Re-Redo was 35.3 months. Although Re-Redo bariatric surgery is an effective treatment for obesity, it carries a significant risk of complications.

Purpose Bariatric surgery is no longer considered only as a weight loss surgery but also a way of treating obesity-related comorbidities such as type 2 diabetes mellitus (T2DM). Short-term T2DM remissions in patients undergoing laparoscopic sleeve gastrectomy (LSG) have been shown, but there are very few reports on the mid-term results. We aimed to assess the remission rate of T2DM in obese patients after LSG throughout 5-year follow-up. Materials and Methodology We performed a retrospective multicenter cohort analysis of 240 patients who underwent LSG. We assessed the remission rate of T2DM 1 year and 5 years after surgery. Results Forty-six percent of patients achieved T2DM remission 5 years after LSG. The remission group had better weight loss results (median% of total weight loss 5 years after: 30.1% (22.9–37.0) vs 23.0% (13.7–30.2), p < 0.001) and were significantly younger than the no remission group (43 (38–52) vs 52 (44–58) years, p < 0.001). Duration of T2DM was significantly shorter (2 (1–5) vs 5 (3–10) years, p < 0.001) with less insulin requirement and less diabetes-related complications (7.2% vs 19.8%, p < 0.001) and significantly lower median DiaRem score (4.0 (IQR 2.0–6.0) vs 12.0 (IQR 5.0–16.0), p < 0.001). Preoperative body mass index (BMI) had no effect on remission. Conclusions Our study suggests that diabetes remission after laparoscopic sleeve gastrectomy occurs frequently, and in the 5-year follow-up, it may remain at the level of 46%. We identified the age of patients, duration, and severity of T2DM as factors affecting mid-term diabetes remission. Nevertheless, further well-designed trials are needed to support our findings.

Introduction: The gastric band is still offered as a good bariatric option for highly motivated and carefully selected patients. The question is whether this faith is justified or not. Aim: To assess long-term clinical outcomes of patients who underwent laparoscopic adjustable gastric banding (LAGB) at a single bariatric center and to examine variables associated with patients' adherence to scheduled postoperative appointments. Material and methods: A retrospective review of patients who underwent LAGB between 2004 and 2009 was performed. The initial cohort included 167 patients. Data regarding sex, age, preoperative weight, hometown population and distance from the bariatric center, and gastric band volume were collected. Compliance was measured as the number of postoperative appointments. Clinical outcome was defined as percent excess weight loss (%EWL) at the end of the observation period or at band removal. Results: The LAGB was performed in 167 patients between 2004 and 2009. The mean follow-up time was 90 +/- 24 months. Five (3%) patients were lost to follow-up; 37 (22.2%) had their band removed. The remaining 125 (74.8%) patients retained their bands and were included in the analysis. The mean %EWL was 33.0 +/- 26.6%. Thirty-one (18.6%) patients achieved %EWL > 50%. Conclusions: This study found that LAGB was not an effective bariatric procedure in long-term observation. Only 25% of 125 patients who maintained a functioning band achieved %EWL > 50%. Compliance was the only independent prognostic factor for weight loss. Other factors had no influence on outcome.

Some of the author affiliations were incorrectly assigned in the original article. They are correct here.

Introduction: Due to the constantly growing demand for surgical treatment of obesity, it is necessary to create new bariatric centers and further improve presently active ones. Aim: To identify which stages of conducting ped-operative care and organizing a modern bariatric center currently pose the greatest challenge. Material and methods: An anonymous survey was designed and distributed to bariatric surgeons. Our questionnaire was divided into three parts: demographic characteristics, difficulties associated with ped-operative care for bariatric patients (assessed on a scale of 1-5) and difficulties associated with organization or running of bariatric centers in which participants are currently working (assessed on a scale of 1-5). Results: Overall, 70 surgeons and surgical residents from 17 surgical centers participated in our survey. The most difficult element of the pre-operative care was compliance with the recommendation to cease smoking (3.47 +/- 1.28). The most difficult obstacle during the postoperative care period was implementation of the enhanced recovery after surgery (ERAS) protocol (2.27 +/- 1.31). Funding for the bariatric treatment was obtained exclusively from the National Health Fund by 60 (85.7%) respondents working in 15 different bariatric centers (88.2%). Among elements of bariatric infrastructure access to operating theater equipment sized for morbidly obese patients was reported to be the most difficult (3.8 +/- 1.68). Conclusions: Pre-operative recommendations including smoking, physical activity or weight loss, as well as introducing ERAS protocol based ped-operative care, are difficult to execute in bariatric departments. Future specialized bariatric centers should be included in the centralized register and equipped with specialized infrastructure for morbidly obese patients.

INTRODUCTION:Among the most common early complications after bariatric surgery are anastomosis leak and bleeding. In order to react quickly and perform accurate treatment before the clinical signs appear, early predictors should be found. In the study C-reactive protein (CRP) and procalcitonin (PCT) levels were investigated. Characterized by a relatively short half-life, they can predict surgical complications.AIM:To develop and implement certain standards for early detection of complications.MATERIAL AND METHODS:The study involved 319 adults who underwent laparoscopic sleeve gastrectomy (LSG) as a surgical intervention for morbid obesity at the Department of General Surgery of Ceynowa Hospital in Wejherowo. Every patient had CRP and PCT levels measured before the surgery and on the 1st and 2nd postoperative day (POD).RESULTS:Early postoperative complications occurred in 19 (5.96%) patients. Septic and non-septic complications occurred in 3 and 16 patients respectively. Among the patients with septic postoperative complications CRP level increased significantly on the 2nd POD compared to the remainder (p = 0.0221). Among the patients with non-septic postoperative complications CRP level increased significantly on the 1st and 2nd POD compared to the remainder. Among the patients with septic and non-septic postoperative complications PCT level increased significantly on the 2nd POD compared to the remainder.CONCLUSIONS:The CRP and PCT level are supposed to be relevant diagnostic markers to predict non-septic and septic complications after LSG.

Introduction: Laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) are acceptable options for primary bariatric procedures in patients with body mass index (BMI) 35-55 kg/m(2).Aim: The aim of this study is to compare the effects of these two bariatric procedures 6, 12 and 24 months after surgery.Material and methods: Two hundred and two patients were included 72 LSG and 130 LAGB patients. The average age was 38.8 +/- 11.9 and 39.4 +/- 10.4 years in LSG and LAGB groups, with initial BMI of 44.1 kg/m(2) and 45.2 kg/m(2), p = NS.Results: The mean percentage of excess weight loss (%EWL) at 6 months for LSG vs. LAGB was 36.3% vs. 30.1% (p = 0.01) and at 12 months was 43.8% vs. 34.6% (p = 0.005). The greatest difference in the mean %EWL at 12 months was observed in patients with initial BMI of 40-49.9 kg/m(2) in favor of LSG (47.5% vs. 35.6%; p = 0.01). Two years after surgery there was no advantage of LSG and in the subgroup of patients with BMI 50-55 kg/m(2) there was a trend in favor of LAGB (57.2% vs. 30%; p = 0.07). The multiple regression model of independent variables (age, gender, initial BMI and the presence of comorbidities) proved insignificant in prediction of the best outcome in means of %EWL for either operative modality None of these factors in the logistic regression model could determine the type of surgery that should be used in particular patients.Conclusions: During the first 2 years after surgery, the best results were obtained in women with lower BMI undergoing LSG surgery. The LSG provides greater %EWL after a shorter period of time though the difference decreases in time.