BACKGROUND:Paraesophageal hernia (PEH) repair via laparoscopy has evolved significantly over the past decades, aiming to reduce the symptoms of recurrence and gastroesophageal reflux disease (GERD). This study evaluates short- and long-term outcomes of laparoscopic PEH repair with emphasis on surgical technique evolution, mesh use, fundoplication, and anterior gastropexy. METHODS:We retrospectively analyzed 341 consecutive patients who underwent laparoscopic repair for primary or recurrent PEH from March 2003 to March 2024. Surgical techniques varied over time, especially concerning mesh type, fundoplication strategy, and use of gastropexy. Main outcomes were recurrence of PEH or GERD. Secondary endpoints included intra- and postoperative complications. RESULTS:Of 341 patients, 91% received mesh reinforcement and 80% underwent fundoplication. Recurrence occurred in 66.7% of patients treated with suture-only hiatoplasty versus 3.9% with mesh reinforcement (P < .001). GERD recurrence was significantly lower in patients with Nissen-Rossetti (0%) and Toupet (7.5%) fundoplication compared to no fundoplication (40.0%) or suture-only hiatoplasty (66.7%). Anterior gastropexy, introduced systematically since 2020, was associated with improved anatomical stability. Early postoperative complications occurred in 8% of patients. The most common was left pleural opening (66.7%), followed by hemopericardium (11.1%), gas bloat syndrome (11.1%), and one case of splenic injury. Two patients experienced gastric wall perforation after fundoplication, requiring reoperation. Overall mortality was 0.6%. CONCLUSION:Tension-free hiatoplasty reinforced with mesh is essential to minimize recurrence. The routine use of anterior gastropexy, particularly in large hernias, further improves anatomical stability. Tailored fundoplication and proper functional assessment complete an effective, individualized surgical approach.

BACKGROUND:Obesity is a leading global health challenge associated with increased morbidity and mortality from cardiovascular disease, type 2 diabetes, hypertension (HTN), and other metabolic comorbidities. Bariatric surgery is currently the most effective long-term treatment for severe obesity. However, 20-30% of patients may experience weight regain or unsatisfactory metabolic outcomes after primary surgery, requiring revisional (redo) procedures. The Single Anastomosis Sleeve Ileal Bypass (SASI) is an innovative bariatric technique, recently proposed as a redo option due to its favorable balance of restrictive and malabsorptive mechanisms and technical simplicity. SASI is still considered "experimental" in major international guidelines, and data on its efficacy as revisional surgery are limited. METHODS:This retrospective study included 30 patients (mean age 50.8 ± 10.75 years) undergoing SASI after failed primary bariatric procedures (sleeve gastrectomy, gastric plication, Bariclip) between 2023 and 2024. Parameters analyzed included weight, body mass index (BMI), percentage of excess weight loss (%EWL), percentage of total weight loss (%TWL), remission of type 2 diabetes (T2DM), HTN, obstructive sleep apnea (OSA), gastroesophageal reflux disease (GERD), surgical complications, nutritional status. Follow-up was conducted at 1, 6, and 12 months postoperatively. RESULTS:Preoperatively, mean weight was 124 ± 29.1 kg and BMI 45.05 ± 5.4 kg/m2. At 1, 6, and 12 months after SASI, mean BMI was 42.85 ± 7.69, 37.6 ± 6.3, and 32.7 ± 3.83 kg/m2, respectively; mean weight was 113 ± 21.6, 99.25 ± 31.3, and 89.1 ± 18 kg. At 12 months, mean %EWL was 57.6 ± 19 and %TWL was 29.58 ± 8.16, exceeding standard benchmarks for bariatric success. Remission rates of T2DM, HTN, OSA and GERD all improved markedly, with nearly complete resolution of comorbidities at 12 months. No peri- or postoperative complications were observed. Considering the nutritional status at 12 months follow-up, no significant alterations were detected. In particular, we chose to analyze laboratory parameters such as serum albumin (3,7 ± 3), vitamin B12 (490 ± 250 pg/mL), folate (9 ± 6 ng/mL), iron (110 ± 32 ug/mL), ferritin (100 ± 35 ng/mL), and hemoglobin (12 ± 1,5). CONCLUSION:The SASI procedure demonstrated significant efficacy and safety as a revisional bariatric surgery, producing substantial weight loss, favorable metabolic improvement, and no surgical complications in this single-center cohort. These findings support the use of SASI as a valid option for redo bariatric procedures. Further prospective studies with larger cohorts and longer follow-up are needed to assess long-term results and nutritional outcomes.

Marked differences in advanced gastric cancer (AGC) surgical outcomes have historically been documented between Eastern and Western centers. This study compared laparoscopic gastrectomy (LG) surgical outcomes for AGC between Japanese and Italian institutions. This international, retrospective cohort study included patients undergoing LG for AGC at 17 Italian (within the Italian Research Group for Gastric Cancer) and 5 Japanese institutions (2015–2022). Propensity score matching (PSM) was used to balance baseline characteristics. The primary endpoint was 90-day severe morbidity (Clavien-Dindo ≥ III). Secondary endpoints were 90-day mortality, R0 resection rates, and lymph node (LN) yield. Multivariable regression identified predictors of severe morbidity. From 1,617 patients, PSM selected 566 cases (283 per group). The Italian group (IG) showed a trend toward higher 90-day severe morbidity (14.8

INTRODUCTION:Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure worldwide. However, the development or persistence of gastroesophageal reflux disease (GERD) remains a significant concern, particularly in patients with preexisting reflux symptoms. In selected bariatric patients affected by symptomatic GERD, alternative surgical strategies may be required. This prospective observational study aimed to evaluate the long-term outcomes of SG combined with Rossetti fundoplication (SGRF) in a selected population of patients with morbid obesity and documented GERD. METHODS:Patients with obesity and preoperative GERD symptoms, chronic proton pump inhibitor (PPI) use, and endoscopic evidence of esophagitis were prospectively enrolled, underwent SGRF, and were followed for more than 5 years. Unlike SG combined with Nissen fundoplication, the Rossetti technique requires a smaller portion of the gastric fundus to construct the antireflux wrap. This aspect may be particularly relevant in bariatric surgery, as SG is based on the resection of most of the gastric fundus, which contains ghrelin-producing orexigenic cells. RESULTS:In total, 38 out of 58 patients enrolled (65.5%) completed long-term follow-up (mean 68.5 months). Of all, 92.1% of patients had discontinued PPIs and reported resolution of reflux symptoms. Among the 24 patients who underwent long-term gastroscopy, 96.6% showed no evidence of esophagitis. The adjusted total weight loss (%TWL) was 26.1%. CONCLUSION:These findings suggest that SGRF may represent a promising surgical option for carefully selected bariatric patients with GERD. Further prospective studies, including objective functional assessments such as esophageal manometry and pH monitoring, are needed to better define the role of this technique.

BACKGROUND:One-anastomosis gastric bypass (OAGB) is increasingly performed worldwide, but concerns persist regarding postoperative gastroesophageal reflux disease (GERD), bile reflux, and related complications. OBJECTIVES:To evaluate the incidence and clinical relevance of GERD and bile reflux after OAGB and to investigate whether preoperative esophageal functional parameters predict postoperative reflux-related complications. SETTING:Department of General Surgery, Policlinico San Marco, Bergamo, Italy. METHODS:This retrospective cohort study included 150 consecutive patients undergoing laparoscopic OAGB between 2016 and 2023. All patients underwent preoperative esophagogastroduodenoscopy and esophageal manometry, with selective pH-impedance monitoring when indicated. Postoperative GERD, esophagitis, bile reflux, anastomotic ulcers, and revisional surgery were assessed during a follow-up of 24-84 months. At last follow-up, 142 patients were available for evaluation, while 8 patients (5.3%) were lost to follow-up. RESULTS:The mean preoperative body mass index was 48 kg/m2, decreasing to 27 kg/m2 at last follow-up. Postoperative GERD developed in 26 patients (17.3%), all of whom had a preoperative hypotensive lower esophageal sphincter (LES) (<16 mmHg). Bile reflux was diagnosed in 30 patients (20%) by pH-impedance monitoring and was refractory to medical therapy in all cases, leading to conversion to Roux-en-Y gastric bypass (RYGB) with complete symptom resolution. Anastomotic ulcers occurred in 15 patients (10%), including 3 perforations (2%). No patient with normal preoperative LES pressure developed GERD or esophagitis. CONCLUSIONS:OAGB is associated with clinically relevant and likely underestimated postoperative GERD and bile reflux. In this cohort, biliary reflux was frequent and uniformly required surgical conversion to RYGB. Preoperative LES hypotonia was associated with postoperative GERD and esophagitis, supporting the role of preoperative functional evaluation in patient selection.

Bariatric surgery is an effective treatment for morbid obesity but is frequently complicated by anastomotic leaks, fistulas, and strictures, which can significantly impair patient outcomes. Optimal management of these complications relies on a timely and accurate diagnostic assessment; however, effective treatment strategies are central to improving clinical recovery. This review primarily focuses on the endoscopic management of post-bariatric surgery complications, while providing a concise overview of the diagnostic imaging modalities that guide therapeutic decision-making. Contrast-enhanced imaging techniques, including computed tomography (CT) and fluoroscopy, as well as endoscopic ultrasound (EUS), are briefly discussed in relation to their role in identifying complications, defining their extent, and selecting the most appropriate endoscopic intervention. The core of this review is dedicated to current endoscopic treatment approaches, including endoscopic internal drainage with double pigtail plastic stents, self-expanding metal stents (SEMSs), endoscopic vacuum therapy (EVT), and EUS-guided drainage of fluid collections. Particular emphasis is placed on indications, technical considerations, and outcomes of these therapies. Finally, this review highlights emerging endoscopic technologies that may further optimize the management of post-bariatric surgery complications and improve patient outcomes, underscoring the evolving role of minimally invasive endoscopic treatment within a multidisciplinary framework.

INTRODUCTION:Occurrence of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) has been the subject of numerous studies and is certainly multifactorial in origin. We believe that conversion to Roux-en-Y gastric bypass (RYGB) is the gold standard, but it may not be suitable for all patients. METHODS:We retrospectively examined 6500 patients who underwent LSG between January 2015 and February 2023 who developed 6 months of GERD unresponsive to medical therapy with descriptive analysis. 240 patients met the inclusion criteria for the study. The GERD-Health-Related Quality of Life (HRQL) questionnaire was used for symptomatic assessment. Perioperative outcomes, progression of GERD symptoms over time, and continued use of proton pump inhibitor therapy postintervention were analyzed. All patients underwent gastrointestinal contrast study (with Gastrografin), esophagogastroduodenoscopy, and HR-esophageal manometry postsurgical revision. RESULTS:Body mass index (BMI) was 43.0 ± 5.2 kg/m2, while BMI before the revision procedure was 25.7 ± 5.2 kg/m2. The mean GERD-health-related quality of life (GERD-HRQL) score before the revision procedure was 14.8 ± 3.5 and decreased to 8.2 ± 3 at 1 month postsurgery. Mean GERD-HRQL scores at 3, 6, and 12 months post-revision were 10.2 ± 3.5, 11.3 ± 4, and 12.1 ± 4, respectively. All patients were taking a daily proton pump inhibitor prior to the revision; only 40% were able to discontinue it after the procedure. 112 patients (46.6%) with a hiatal hernia, normotonic or slightly hypotonic lower esophageal sphincter (LES) were satisfied with the intervention; 72 (30%) had a neutral attitude, and 56 patients with a hypotonic LES (21.4%) reported unchanged symptoms. Of these 56, 20 (35.7%) patients agreed to undergo one-anastomosis gastric bypass (OAGB), and 16 (28.6%) chose RYGB. 14/20 (70%) of those who converted from LSG to OAGB required reconversion to RYGB due to significant bile reflux. After the second revision, an immediate resolution of symptoms was observed. CONCLUSIONS:Only hiatal hernia repair could be an acceptable treatment option for the occurrence of GERD after LSG in selected cases.

Mild acute biliary pancreatitis (MABP) presents significant clinical and economic challenges due to its potential for relapse. Current guidelines advocate for early cholecystectomy (EC) during the same hospital admission to prevent recurrent acute pancreatitis (RAP). Despite these recommendations, implementation in clinical practice varies, highlighting the need for reliable and accessible predictive tools. The MINERVA study aims to develop and validate a machine learning (ML) model to predict the risk of RAP (at 30, 60, 90 days, and at 1-year) in MABP patients, enhancing decision-making processes. The MINERVA study will be conducted across multiple academic and community hospitals in Italy. Adult patients with a clinical diagnosis of MABP, in accordance with the revised Atlanta Criteria, who have not undergone EC during index admission will be included. Exclusion criteria encompass non-biliary aetiology, severe pancreatitis, and the inability to provide informed consent. The study involves both retrospective data from the MANCTRA-1 study and prospective data collection. Data will be captured using REDCap. The ML model will utilise convolutional neural networks (CNN) for feature extraction and risk prediction. The model includes the following steps: the spatial transformation of variables using kernel Principal Component Analysis (kPCA), the creation of 2D images from transformed data, the application of convolutional filters, max-pooling, flattening, and final risk prediction via a fully connected layer. Performance metrics such as accuracy, precision, recall, and area under the ROC curve (AUC) will be used to evaluate the model. The MINERVA study aims to address the specific gap in predicting RAP risk in MABP patients by leveraging advanced ML techniques. By incorporating a wide range of clinical and demographic variables, the MINERVA score aims to provide a reliable, cost-effective, and accessible tool for healthcare professionals. The project emphasises the practical application of AI in clinical settings, potentially reducing the incidence of RAP and associated healthcare costs. ClinicalTrials.gov ID: NCT06124989.

BACKGROUND:Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions-LSI, medical therapy-MT, obesity management medication-OMM or endobariatric procedures-EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity. METHODS:We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL). RESULTS:A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon-IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality. CONCLUSIONS:MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity.

Surgical repair of incisional ventral hernias (VH) is a standard procedure globally, with an increasing role in minimally invasive techniques. This study aims to evaluate postoperative outcomes in emergency repairs for VH, comparing surgical features of open and laparoscopic approaches. A retrospective multicentric study (ACTIVE study) was created to evaluate the surgical outcome of VH repair in emergency settings. Data were collected from demographic, preoperative, intra-operative, and postoperative variables, focusing on 30-day morbidity and other short- and long-term outcomes. Data from 556 patients who underwent emergency VH repair were collected and analyzed, with 175 patients treated with a Minimally Invasive (MIS) approach (31.5

Wandering spleen is a rare condition that can necessitate urgent laparotomic splenectomy. Prompt recognition of symptoms is crucial for preserving the spleen by performing laparoscopic splenopexy. We present a laparoscopic technique that enables safe and durable splenopexy using a composite keyhole-shaped mesh (13-month follow-up).

Background: The study is designed to compare laparoscopic and anterior sutureless techniques for repairing inguinal hernia. Methods: For several years, our group has performed both laparoscopic and anterior sutureless inguinal hernia repairs. This retrospective cohort study analyzed 160 patients with inguinal hernias who underwent sutureless surgical alloplasty between July 2018 and July 2019. Eighty patients were treated laparoscopically (transabdominal preperitoneal approach) with a polypropylene mesh secured with fibrin glue (Tisseel®; Baxter Health, Deerfield, IL). The remaining 80 patients underwent open alloplasty using a preformed double-layered polypropylene mesh (Folded-Mesh; Angiologica, Italy) that did not require suture or glue fixation. Clinical follow-up data were collected for a period of 60 months. Results: The two groups were comparable in terms of age, gender, and ASA score. There was no statistically significant difference in operative time between the laparoscopic and open techniques (34.16 ± 8.50 versus 40.17 ± 7.92 minutes; P > .05). No laparoscopic procedure required conversion to open surgery. No perioperative complications were reported in either group. A significant difference was observed in postoperative neuralgia, with 0 cases in the laparoscopic group versus 8 cases in the open group (P < .05). Persistent pain (lasting more than 6 months) was reported in only 2 patients in the open group (P > .05). Relapse was only observed in the open repair group. Conclusions: Sutureless inguinal hernia repair is a safe and effective procedure with minimal complications. The laparoscopic approach appears to be superior, offering a faster recovery and fewer postoperative issues, making it the preferred choice for sutureless hernia repair.

Introduction and Objective: The development of type 1 diabetes (T1D) is linked to elevated insulin resistance (IR), with individuals at risk of T1D showing increased frequencies of circulating insulin-specific CD8 T cells. We hypothesized that CD8 T cells from the visceral adipose tissue (VAT) of T1D and type 2 diabetes (T2D) patients share phenotypic traits indicative of IR. Methods: CD8 T cells were isolated from the stromal vascular fraction (SVF) of VAT obtained from T1D patients undergoing kidney-pancreas transplantation, obese patients with T2D (OB-T2D) or without diabetes (OB-ND) undergoing bariatric surgery, and lean controls (LC) undergoing cholecystectomy. Single-cell RNA and TCR sequencing (scRNA/TCR-seq) were performed to characterize VAT-derived CD8 T cell phenotypes and TCR clonotypes. Results: Preliminary analysis identified 18 CD8 T cell clusters in VAT, with memory cells exhibiting cytotoxic and exhausted phenotypes predominating across all groups. Terminally exhausted CD8 T cells, iNKT cells, NK-like cells, and proliferating CD8 T cells were enriched in T1D patients, whereas OB-T2D samples showed higher frequencies of pro-inflammatory and cytotoxic CD8 T cells. TCR sequencing revealed a more heterogeneous repertoire in T1D, with expanded clonotypes in transitional and polyfunctional CD8 T cells. Database searches for TCR antigen specificity identified public clonotypes predominantly specific to viral antigens, with no matches to islet autoantigens. Conclusion: Preliminary findings indicate an altered CD8 T cell profile in the VAT of T1D patients, characterized by expanded transitional and polyfunctional subsets. The absence of islet-specific public TCR clonotypes and the predominance of virus-specific clonotypes suggest that viral antigens may play a significant role in shaping the T cell repertoire within VAT. A. Petrelli: None. N. Baldoni: None. A. Giovenzana: None. V. Codazzi: None. F. Aleotti: None. V. Tomajer: None. G. Cesana: None. S. Olmi: None. M. Falconi: None. L. Piemonti: Research Support; Dompé. Advisory Panel; Vertex Pharmaceuticals Incorporated, Novo Nordisk, Sanofi. P. Fiorina: Consultant; Novo Nordisk, AstraZeneca. Board Member; Boehringer-Ingelheim. JDRF (1-FAC-2025-1632-A-N)

Studies on morbid obese diabetic and non-diabetic patients’ social characteristics and habits, in candidates for bariatric surgery (BS) are few. To gain further insights, we investigated 799 morbid obese diabetic (n = 111) and non-diabetic patients (n = 688). Family history of cardiometabolic diseases, personal history, education and occupation, comorbidities, daily habits, previous dietetic treatment, reasons and pathway to BS were investigated. Team members involved and examinations performed were also analyzed. Family histories of obesity, diabetes and hypertension significantly associated with each other, and clinically overt diseases were also associated with family histories of the same disease, as diabetes and hypertension, and were more frequent in diabetic as compared to non-diabetic (p > 0.05, p < 0.0001 and p < 0.05). Females significantly differed from males for lower body mass index (BMI) (mean 41.2 vs 42.8 kg/m2), and a lower alcohol intake (p < 0.05 to p < 0.001). Knowledge about BS and reasons for BS varied according to age. BS was mostly requested for medical reasons (80.1

Acute Pancreatitis (AP) is a prevalent clinical pancreatic disorder characterized by acute inflammation of the pancreas, frequently associated with biliary or alcoholic events. If not treated with cholecystectomy after the first episode, patients may experience a recurrence of AP, with consequent need for emergency surgery and increased risk of death. Analyzing the risk factors that may contribute to the recurrence of Biliary and Alcoholic Pancreatitis (BAP and AAP), future research can be driven toward new solutions for preventing and treating this pancreatic disease. A systematic review was conducted selecting studies from BiomedCentral, PubMed, Scopus and Web of Science by two independent reviewers. Publications were considered only if written in English in the time interval between January 2000 and June 2024 and investigated the risk factors for the recurrence of BAP and AAP. At the end of the selection, a quality assessment phase was conducted using the PROBAST tool. In this systematic review, 8 articles were selected out of 6.945, involving a total sample of 11.271 patients of which 38.77

Background: The aim of this study is to compare the postoperative outcomes of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique with the defect closure technique using sutures and intraperitoneal mesh (IPOM plus), evaluating recurrence and bulging rates at least one year postoperatively. The secondary objective is to compare postoperative complications: seroma and pain at 30 days, 6 months, and 1 year post-surgery. Methods: Patients with midline primary ventral and incisional hernias between 4 and 10 cm were included. A CT scan was performed on all patients to assess the correct spatial values preoperatively and at 1 month, 6 months, and 12 months postoperatively. Pain was evaluated using the visual analog scale. Results: A total of 50 patients underwent LIRA, and 48 patients underwent IPOM plus between January 2022 and May 2023. The mean defect area in the LIRA group was larger than in the IPOM plus group (63.5 ± 37.5 cm2 versus 55.2 ± 33.9 cm2). In the LIRA group, 2/48 instances of bulging (4.4%) occurred, whereas in the IPOM plus group, there were 6/50 instances of bulging (21.3%) and 2/50 recurrences (6.4%). One month post-surgery, a clinical seroma was observed in 8/48 patients (16%) and 9/50 patients (18.7%) in the LIRA and IPOM plus groups, respectively, with complete resolution at 6 months. Postoperative pain was found to be lower in the LIRA group. Conclusions: In this study, the LIRA technique demonstrated lower rates of bulging, recurrence, and postoperative pain compared with IPOM plus at 1 year of follow-up. Further multicentric prospective studies with a larger patient sample and longer follow-up are necessary to draw definitive conclusions.

Sequential endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy (EST) followed by laparoscopic cholecystectomy (LC) is a standard minimally invasive approach for treating concomitant gallbladder and common bile duct stones. This study presents a 30-year experience with this strategy and compares its outcomes with emerging single-session techniques, including laparoscopic common bile duct exploration (LCBDE) and laparoendoscopic rendezvous (LERV). Between October 1991 and December 2020, a total of 350 patients (mean age 65 years, range 35–80) underwent EST and/or ERCP followed by LC in a sequential treatment protocol for choledocholithiasis. Patient demographics, intra- and post-procedural variables, complication rates, and long-term outcomes were retrospectively reviewed. The success rate of stone clearance, morbidity, mortality, and recurrence rates were calculated. Of the 350 treated patients, 240 (68.6

Linear magnetic compression is a novel technique to perform gastrointestinal anastomosis. This Italian multi-center clinical investigation aimed to evaluate the feasibility, safety and efficacy of the creation of a side-to-side compression anastomosis using the GT Metabolic Solutions™ Magnet System, DI Biofragmentable (MagDI™ System) to achieve duodeno-ileal diversion. Patients with a body mass index (BMI) of ≥ 30 to 50 kg/m2 and weight regain and/or type 2 diabetes mellitus (T2DM) after sleeve gastrectomy (SG) and patients with a BMI of ≥ 30 to 35 kg/m2 and T2DM underwent a side-to-side duodeno-ileal diversion using the GT Metabolic™ DI Magnet (linear, 39 mm). 28 patients (19 F) underwent surgery in 4 centers in the time between 09/24 and 02/25. Mean age and BMI were 44 years and 36.7 ± 4.4 kg/m2. Mean operative time and hospital stay were 73.2 min and 1.6 days. Paired magnets were expelled in all patients in a mean of 37.3 days. There were three procedure-related serious adverse events (Clavien Dindo III, one ileal perforation on POD 1, one liver insufficiency leading to reversal on POD 144 and one trocar site hernia on POD 203). Mean BMI,