BACKGROUND Metabolic and bariatric surgeries (MBS) are effective treatments for obesity and related comorbidities, such as diabetes and hypertension. In patients with morbid obesity and challenges like hepatomegaly, conventional procedures may increase risks. Staged MBS was developed to address these issues, enhancing safety. This report highlights the successful use of isolated intestinal transit bipartition with duodeno-ileal anastomosis, preserving the duodenum, as the first stage of the duodenal switch. CASE REPORT A 40-year-old woman with a BMI of 40.2 kg/m² was booked for MBS. Severe hepatomegaly impaired safe access to the esophagogastric junction, leading to the performance of only the intestinal stage of the duodenal switch. A duodeno-ileal anastomosis was created 250 cm from the ileocecal valve, preserving the stomach and partial duodenal function. Without the gastric stage, the patient achieved 50 kg of weight loss (equivalent to 78.7% excess weight loss) over 19 years, without requiring additional surgery. Minor complications included occasional diarrhea, meteorism, and difficulties with vitamin supplementation, all managed effectively through dietary adjustments and nutritional guidance. A benefit was increased satiety. CONCLUSIONS Isolated intestinal transit bipartition with duodeno-ileal anastomosis is an approach that may be used in exceptional cases, such as with this patient. Despite the favorable long-term follow-up results, further studies are necessary to better understand this approach. This method demonstrated sustained weight loss and long-term metabolic control, potentially representing a promising initial treatment option for patients with lower BMIs, including those with type 2 diabetes.

Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide, but gastroesophageal reflux disease (GERD) remains a significant long-term complication affecting 20–35

Sleeve gastrectomy (SG) may precipitate or worsen gastroesophageal reflux disease (GERD), sometimes necessitating conversion to gastric bypass. Both Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) have been proposed as revisional procedures, yet comparative data on GERD outcomes remain limited. This study encompassed analysis of PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov from database inception through November 2024. Studies comparing OAGB with RYGB as conversion procedures after failed SG were included. Primary outcomes were GERD resolution rate and de novo GERD incidence. Secondary outcomes included weight loss parameters (

BACKGROUND:Metabolic and bariatric surgery is the most effective treatment for severe obesity. While short- and mid-term results are well documented, very long-term data (≥10 years) remain scarce, particularly for newer procedures. This review aims to synthesize the available evidence on weight loss outcomes, comorbidity resolution, and complications at 10 years and beyond for the five main bariatric procedures. METHODS:A comprehensive literature review was performed using PubMed, MEDLINE, and Cochrane databases. Studies reporting outcomes at ≥10 years for sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodeno-ileal bypass with sleeve (SADI-S) were included. RESULTS:At 10 years, weighted mean %TWL ranged from 24.4% for SG to approximately 40% for BPD-DS. The SLEEVEPASS randomized controlled trial demonstrated superior weight loss with RYGB compared to SG (%EWL 51.9% versus 43.5%, P < .05). OAGB showed excellent durability with a %EWL of 64.1% at 10 years. BPD-DS achieved the highest sustained weight loss (%EBMIL 76.5%-78%) but with significant nutritional concerns. SADI-S data at 10 years showed %EWL of 80% with acceptable complication rates. Type 2 diabetes remission rates varied from 26% to 33% (SG/RYGB) to >90% (BPD-DS). Gastroesophageal reflux disease (GERD) emergence was a major concern after SG (31% esophagitis at 10 years versus 7% after RYGB). CONCLUSIONS:All five procedures demonstrate durable weight loss at 10+ years, with a clear hierarchy favoring malabsorptive procedures for weight loss efficacy. Procedure selection should consider patient-specific factors, including baseline BMI, presence of GERD, metabolic comorbidities, and capacity for long-term nutritional follow-up.

Background: Marginal ulcer (MU) is a well-recognized complication following Roux-en-Y gastric bypass (RYGB), with a reported prevalence of 0.6%-16%. While most ulcers respond to medical therapy with proton pump inhibitors and risk factor modification, a subset of patients develop refractory ulcers requiring surgical intervention. Despite this clinical challenge, there remains no consensus on the optimal surgical approach for refractory MU.Methods: We performed a narrative review of the literature using PubMed, MEDLINE, and Google Scholar databases from January 2000 to December 2024. Search terms included marginal ulcer, anastomotic ulcer, gastric bypass, refractory ulcer, surgical treatment, vagotomy, and revisional surgery. We focused on studies reporting surgical outcomes for refractory MU after RYGB.Results: Current surgical options include (1) gastrojejunostomy revision with or without pouch reduction, (2) truncal vagotomy (laparoscopic or thoracoscopic), (3) subtotal or total gastrectomy with esophagojejunostomy, (4) gastric remnant resection, and (5) RYGB reversal with or without conversion to sleeve gastrectomy. Reported success rates vary from 36% to 100% depending on technique and follow-up duration. Recurrence rates remain concerning, ranging from 15% to 57% at 1 year. Risk factors for recurrence include persistent smoking (HR: 5.03), immunosuppression (HR: 4.60), and Nonsteroidal anti-inflammatory drug (NSAID) use (HR: 3.11). Emerging endoscopic approaches, including suturing and stent deployment, show promise as step-up therapy before surgical revision.Conclusions: The management of refractory MU after RYGB remains challenging with no single optimal surgical approach. Treatment should be individualized based on ulcer characteristics, the presence of associated complications (gastrogastric fistula and stricture), and patient risk factors. A stepwise algorithm incorporating endoscopic therapy, gastrojejunostomy revision, and salvage procedures is proposed.

BACKGROUND:Gastroesophageal reflux disease following laparoscopic sleeve gastrectomy (LSG) affects up to 40% of patients. Magnetic sphincter augmentation (MSA) has emerged as a less invasive alternative to Roux-en-Y gastric bypass, but device erosion remains a critical concern in postbariatric populations. OBJECTIVES:To evaluate MSA erosion rates after LSG and compare them with general populations, while identifying risk factors and clinical outcomes. SETTING:Multi-institutional systematic review and meta-analysis. METHODS:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus through September 2025. Primary outcome was device erosion rate. Secondary outcomes included time to erosion, risk factors, clinical presentation, and management. Random-effects meta-analysis with heterogeneity assessment was performed. RESULTS:Analysis of 14 studies encompassing 287 patients with median follow-up of 24 months revealed overall erosion rate of 3.8% (11/287), significantly higher than .1%-.3% in nonbariatric populations (P < .001). Median time to erosion was 18 months. Factors associated with erosion included body mass index > 30 kg/m2 at MSA (odds ratio [OR]: 3.2), absence of hiatal repair (OR: 4.1), device undersizing (OR: 3.8), and persistent sleeve dilatation (OR: 2.7). Most erosions (72.7%) presented with dysphagia; all required explantation with 90.9% symptom resolution. CONCLUSIONS:MSA erosion risk after LSG is elevated compared to nonbariatric populations but remains below 4% with proper patient selection, and must be weighed against the 7%-8% complication rate of Roux-en-Y gastric bypass conversion. Based on very low to low-certainty evidence, body mass index optimization, adequate hiatal repair, appropriate device sizing, and sleeve evaluation may help minimize erosion risk in this population, although these recommendations require prospective validation.

One Anastomosis Gastric Bypass (OAGB) and Single Anastomosis Sleeve Jejunal Bypass (SASJ) represent two distinct single-anastomosis bariatric procedures that share similar anatomical configurations but differ fundamentally in their approach to duodenal transit. While OAGB excludes the duodenum completely from nutrient flow, SASJ partially reserves duodenal transit through a bipartition mechanism. This fundamental difference raises a critical question in metabolic surgery: how much does duodenal exclusion matter for weight loss and metabolic outcomes? We conducted a narrative review of the current literature comparing the anatomical, physiological, and clinical aspects of OAGB and SASJ, with particular emphasis on the role of duodenal exclusion in weight loss mechanisms, metabolic improvements, and nutritional consequences. Both procedures demonstrate excellent weight loss (EW) outcomes with comparable excess weight loss (EWL) ranging from 70-85

BACKGROUND Sleeve gastrectomy (SG) is widely used in obesity treatment, although it is associated with new onset of gastroesophageal reflux disease (de novo GERD) and weight regain. Roux-en-Y gastric bypass (RYGB) is the standard revisional procedure for GERD, though it offers limited additional weight loss. Ileal-based procedures have demonstrated superior outcomes regarding weight loss but have uncertain results in GERD. This study presents preliminary findings on gastric bipartition with functional duodenal exclusion (GBp-FDE) as a revisional approach following SG in this scenario. CASE REPORT A retrospective data analysis was conducted on 10 patients who underwent GBp-FDE due to de novo GERD and obesity recurrence after SG (mean BMI: 37.2±3.2 kg/m²). Nine patients presented with hiatal hernia and 8 with sleeve dilation. GERD was assessed pre- and postoperatively using a validated questionnaire, endoscopy, and contrast radiology. The surgical technique involved a pre-pyloric antroileostomy in Roux-en-Y configuration using a 40% proportion biliopancreatic limb. One-year postoperative findings included pyloric spasm (endoscopy), very preferential contrast flow to the ileum (radiology), and endoscopic access preservation to the duodenum. GERD symptoms resolved in 90% (P=0.0059) and esophagitis healed in 80% (P=0.008), likely due to gastric decompression. Mean percent total weight loss and percent excess weight loss were 35.2±6.6 and 108.0±11.14, respectively. CONCLUSIONS GBp-FDE seems to be a promising surgery for managing de novo GERD and obesity recurrence after SG, through SG pouch decompression and ileal stimuli, promoted by the antroileostomy. Further controlled studies with extended follow-up are necessary to validate these findings.

Artificial intelligence (AI) is transforming the landscape of medicine, including surgical science and practice. The evolution of AI from rule-based systems to advanced machine learning and deep learning algorithms has opened new avenues for its application in metabolic and bariatric surgery (MBS). AI has the potential to enhance various aspects of MBS, including education and training, decision-making, procedure planning, cost and time efficiency, optimization of surgical techniques, outcome and complication prediction, patient education, and access to care. However, concerns persist regarding the reliability of AI-generated decisions and associated ethical considerations. This study aims to establish a consensus on the role of AI in MBS using a modified Delphi method. A panel of 68 leading metabolic and bariatric surgeons from 35 countries participated in this consensus-building process, providing expert insights into the integration of AI in MBS. Of the 28 statements evaluated, a consensus of at least 70% was achieved for all, with 25 statements reaching consensus in the first round and the remaining three in the second round. Experts agreed that AI has the potential to enhance the evaluation of surgical skills in MBS by providing objective, detailed assessments, enabling personalized feedback, and accelerating the learning curve. Most experts also recognized AI’s role in identifying qualified candidates for MBS referrals, helping patient and procedure selection, and addressing specific clinical questions. However, concerns were raised about the potential overreliance on AI-generated recommendations. The consensus emphasized the need for ethical guidelines governing AI use and the inclusion of AI’s role in decision-making within the patient consent process. Furthermore, the results suggest that AI education should become an essential component of future surgical training. Advancements in AI-driven robotics and AI-integrated genomic applications were also identified as promising developments that could significantly shape the future of MBS.

Laparoscopic vertical clip gastroplasty (LVCG) with BariClip is a recent procedure that appears to be safe Gentileschi et al. (Obes Surg 33(1):303-12, 2023). The initial complications reported include erosion, slippage, and gastroesophageal reflux. This study aimed to report on the experience of a single surgical group, analyzing three clinical cases, conducting a literature review, and proposing a standardization of the technique. A retrospective study was conducted with data from June 2021 to October 2024. We collected the data from the procedures related to the bariatric clip made by only one surgical group; we collected 69 cases with 1 complication of this surgical group. Additionally, we described 2 clinical cases of complications related to bariatric clips from other surgical institutions and reviewed the literature related to the BariClip experience. The results are related to the evaluation of the technique and compare the different modifications implemented over the last 3 years of follow-up. Furthermore, we aim to share our experience in attending to one of the most concerning complications associated with this procedure. The LVCG is a safe procedure with a low incidence of complications and positive results in

Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70