Burnout has emerged as an increasingly prevalent risk to the health and performance of surgeons. Metabolic and bariatric surgery (MBS) is a high-stakes, highly technical specialty with complex patient care and extended work hours coupled with heavy procedural demands. The purpose of this study was to evaluate the prevalence and determinants of burnout and resilience among MBS surgeons worldwide and identify variables responsible for these outcomes. A cross-sectional online survey was conducted between January-March 2025 among 419 International Federation for the Surgery and Other Therapies of Obesity (IFSO) members. The Maslach Burnout Inventory (MBI), the 10-item Connor–Davidson Resilience Scale (CD-RISC), and demographic, lifestyle, and professional questions were administered. All scoring followed validated norm-based methods. The mean total MBI scores were 15.55 ± 9.65 for burnout (section A), 9.83 ± 7.65 for depersonalization (section B), and 36.82 ± 8.89 for personal achievement (section C), showing a low to moderate general burnout level overall. High emotional exhaustion and depersonalization were seen among older surgeons, those with sleeping problem, low physical activity, and longer surgical shifts. The levels of resilience (CD-RISC-10 mean = 28.75 ± 6.13) were higher in surgeons with high quality sleeping, greater experience, and academic involvement, but lower in those who actively engaged in research. Despite high burnout indicators, most participants reported strong personal accomplishment and purpose in their work. While nearly 95

Roux-en-Y gastric bypass (RYGB) is an effective bariatric procedure but may be complicated by rare yet serious adverse events, including jejunojejunal intussusception (JJI). This systematic review and meta-analysis aimed to evaluate the incidence, clinical presentation, diagnostic modalities, management strategies, and recurrence of JJI following RYGB to inform clinical practice. A systematic review was conducted in accordance with PRISMA guidelines. Studies reporting JJI after RYGB were identified and assessed for incidence, recurrence, and clinical outcomes. Study quality was evaluated using the Newcastle–Ottawa Scale. Pooled analyses were performed using Comprehensive Meta-Analysis software. Heterogeneity was assessed using Cochran’s Q and the I² statistic. Meta-regression analyses explored associations between clinical variables and recurrence risk. Nine retrospective studies including 223 patients were analyzed, revealing 0.7

The prevalence of revision and conversion metabolic bariatric surgery (MBS) has increased alongside the growing number of primary Roux-en-Y gastric bypass (RYGB) procedures performed worldwide. Common indications for revision or conversion after RYGB include weight recurrence (WR), suboptimal clinical response (SoCR), and late postoperative complications such as internal hernia, marginal ulcers, malnutrition, dumping syndrome, and post-bariatric hypoglycemia. However, high-quality comparative evidence remains limited, and no international consensus exists regarding optimal management strategies. This study aimed to evaluate current international practices and expert opinions on revision and conversion surgery after RYGB through a global expert survey. This international online binary survey comprised 61 questions and was conducted via SurveyMonkey™ between November 14 and December 10, 2025. A total of 188 specialists participated (75.2% of invitees), with 184 completing the questionnaire (98% completion rate). Item-specific response rates ranged from 177 to 187. The survey demonstrated broad international agreement that WR and SoCR are multifactorial conditions requiring individualized, multidisciplinary management. Endoscopic approaches were generally favored as first-line options in selected patients with anatomical dilation, whereas hypoabsorptive procedures (distal RYGB, SADI-S, BPD-DS) were considered more effective for long-term weight loss and metabolic outcomes. High agreement (> 90%) was observed for multidisciplinary follow-up, individualized procedure selection, lifelong nutritional surveillance, and management of several late complications. Important areas of controversy remain. These findings provide preliminary insights that may support future standardized definitions, clinical pathways, and evidence-based guidelines.

Metabolic and Bariatric Surgery (MBS) is an established treatment for obesity and its associated metabolic conditions. As obesity prevalence has risen globally over the past two decades, so too has MBS utilization, spurring interest in same-day discharge (SDD) protocols as a cost-effective alternative to inpatient hospitalization. Following the GRADE methodology, this position statement presents a systematic review of all evidence relevant to same-day discharge in MBS. The current position statement was developed using data from a systematic review and meta-analysis (conducted after Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)) included 17 studies encompassing 46,578 patients; four were randomized controlled trials (RCTs) analyzed in the primary meta-analysis. The pooled analysis of four RCTs (n = 2,026) revealed no statistically significant differences between SDD and conventional inpatient groups for complication rates (OR: 1.49; 95

Metabolic and bariatric surgery (MBS) is highly effective for severe obesity but carries rare, serious risks, most notably venous thromboembolism (VTE), the leading cause of postoperative death. Strikingly, most VTE events occur after patients leave the hospital. Yet, despite guidelines, there is no global agreement on prevention strategies. This international expert consensus unites specialists worldwide to provide clarity and practical recommendations for safer outcomes in MBS. This study used a two-round modified Delphi process to unite 102 experts from 42 countries on thromboprophylaxis in MBS. Guided by evidence and ethical approval, participants, surgeons, hematologists, and pharmacologists reviewed 25 statements online. In the second round, the remaining three were revised and re-evaluated. This method ensured balanced input, minimized bias, and produced a robust international consensus to guide safer surgical practice. In round one, 22 of 25 statements met the ≥ 80% consensus threshold. In round two, the experts re-evaluated the remaining three statements, with one more reaching agreement. Overall, consensus was achieved on 23 of 25 statements. This international Delphi consensus achieved agreement on 23 of 25 statements (92%), offering evidence-based guidance for VTE prophylaxis in MBS. Key recommendations include individualized risk assessment, extended prophylaxis for high-risk patients, preference for LMWH, and growing support for direct oral anticoagulants (DOACs), especially apixaban. The consensus promotes personalized strategies over uniform protocols while highlighting research priorities on dosing, duration, and DOAC comparisons. Implementing these recommendations can standardize care, improve safety, and reduce VTE-related morbidity and mortality worldwide.

Obesity is a chronic relapsing disease associated with increased morbidity and mortality and reduced quality of life. The present GRADE-based guidelines have been commissioned by the Italian Society of Obesity (SIO) by the Italian National Health Institute to provide evidence-based recommendations on obesity diagnosis and treatment. The panel identified 13 clinical questions, organised into four domains: A. diagnostic criteria (4 questions); B. medical nutrition therapy (4 questions); C. pharmacological, surgical, and endoscopic treatments (4 questions); and D. miscellaneous (1 question). The expert panel recommends adopting at least one anthropometric index of abdominal visceral fat distribution beyond body mass index (BMI) for better clinical risk stratification. A structured lifestyle intervention (i.e., medical–nutritional treatment—MNT), preferably based on cognitive–behavioural therapeutic approach and including physical activity and a balanced diet, should be offered to all subjects living with obesity. Pharmacological or surgical treatment should be offered in addition to MNT when MNT is unable to reach clinical goals. In particular, pharmacological treatment should be considered as the preferred option for subjects with BMI > 27 kg/m2 with comorbidities, and for those with BMI 30–39.9 kg/m2, based on individual therapeutic goals and needs, adopting surgical treatment in selected cases or in case of OMM failure to reach clinical goals. For subjects with a BMI > 40 kg/m2, surgical treatment may be considered conversely as a preferable option. Reduction of at least 10

Despite the growing popularity of one anastomosis gastric bypass (OAGB) as the third most commonly performed metabolic and bariatric surgery (MBS) procedure worldwide, concerns remain among MBS surgeons about performing OAGB in children and adolescents. This international expert survey was conducted to assess the perspectives of experts regarding the different aspects of OAGB specific to these patient groups. A total of 102 expert MBS surgeons from 41 countries were invited to participate in this survey, which took place between 24 May 2024, and 11 June 2024. The participating surgeons provided their responses through a 30-question online survey, employing a multiple-choice format. Approximately 6.85% of participants believe there should be no minimum age limit for OAGB and 26.5% of experts perform OAGB only in patients 18 years old and above. The experts define adherence to postoperative diet, patient cooperation, and managing family expectations as the main challenges encountered when performing OAGB in this population. About 92.2% of experts believe that consultation and follow-up by a paediatrician, as part of a multidisciplinary team (MDT), are essential before surgery. Also, 76.5% of experts believe that bone age should be determined in these age groups before OAGB. Despite the absence of strong evidence refuting the safety and efficacy of OAGB in children and adolescents, this survey revealed that there are still some concerns about the long-term safety and efficacy of OAGB in children and adolescents.

Obesity is recognised as a chronic, relapsing and progressive disease, and long-term weight maintenance remains one of the greatest challenges in obesity management. When treatment gets interrupted, recurrent weight gain might be expected. Funding structures for MBS in numerous health systems globally do not currently permit metabolic and bariatric surgery (MBS) to prevent recurrent weight gain in patients who are normal weight or overweight. Gastric band removal is frequently required due to long-term complications such as slippage, which raises an important question: should revisional MBS be considered for weight maintenance in patients who have successfully lost weight after gastric banding? With the increasing use of obesity management medications and the associated successful weight loss, we anticipate that more patients will discontinue pharmacological treatment after reaching a normal weight or overweight range. However, many of these patients may still seek MBS for long-term weight maintenance. We question whether weight maintenance should be considered an indication for MBS in patients who are currently normal weight or overweight but have a history of severe obesity and must discontinue their current obesity treatment.

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.

Overweight and obesity are substantial, growing public health concerns due to their huge direct and indirect negative impact on health. Obesity-associated complications and comorbid conditions include metabolic, cardiovascular, renal, liver and respiratory diseases, cancers, and functional limitations, leading to higher all-cause and cardiovascular mortality, and incident disability. The development of rigorous guidelines considering and comparing all possible therapeutic strategies is of critical importance, and a relevant tool for improving the quality of care and increasing the appropriateness of therapeutic choices. The Italian National Institute of Health (ISS—Istituto Superiore di Sanità) appointed the Italian Obesity Society (SIO—Società Italiana dell’Obesità) and other key scientific societies with a relevant stakeholder role on the theme issue to design and develop a new Italian guideline for the management of obesity in adult subjects, aimed at assisting healthcare professionals in the consideration of lifestyle, pharmacological, endoscopic, and surgical options for the treatment of overweight and obesity, as well as related conditions. We adopted Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology, strongly endorsed by Istituto Superiore di Sanità to develop trustworthy guidelines to be accepted onto Sistema Nazionale Linee Guida, the reference repository of national clinical practice guidelines for the Servizio Sanitario Nazionale.

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,

One anastomosis gastric bypass (OAGB) is now the third most common metabolic and bariatric surgery around the world, but the impact of different long-term complications such as dumping syndrome (DS) need still to be addressed. This study aims to the incidence of DS after OAGB through a systematic review of published papers on PubMed, and Scopus. Finally, 17 studies included 3420 patients were included. The mean postoperative follow-up was 11.91 ± 1.5 months. The incidence of DS was reported between 9 to 42.9

One-anastomosis gastric bypass (OAGB) has gained increasing popularity as a metabolic and bariatric procedure due to its technical simplicity, promising weight loss and metabolic outcomes. However, its indications, long-term efficacy and long-term safety, remain the subject of an ongoing investigation. A systematic review of retrospective and prospective studies evaluating OAGB with a follow-up of minimum five years was conducted. 22 studies encompassing a total of 14,692 patients were included. The analysis included data on patient demographics, surgical indications, comorbidities, weight loss outcomes, and post-operative complications. Studies varied in design, with case numbers ranging from 101 to 2678 patients. Mean follow-up was 89.04 months (min 60 months, max 180 months). Patient age range was 33.8 to 47 years. Body mass index at surgery was between 33.4 and 54 kg/m2. Total weight loss rate ranged from 24.62