Obesity Surgery最新文献

A network meta-analysis of randomized controlled trials (RCTs) was conducted to establish the ranking of various bariatric surgeries in mid- and long-term follow-up durations for people with type 2 diabetes mellitus (T2DM), based on T2DM remission, HbA1c levels, and cardiometabolic outcomes. We searched PubMed, Embase, Medline, and Cochrane Central databases. A common comparator was identified between interventions to develop a network. Mean difference (MD) and 95% confidence interval (CI) were estimated between interventions. Direct and indirect evidence were pooled using the random-effect model. Eleven RCTs and four bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic-adjustable gastric banding (LAGB), biliopancreatic diversion without duodenal switch (BPD), sleeve gastrectomy (SG), and medical/lifestyle treatment (MT) as a comparator group, were included. RYGB, LAGB, BPD, SG, as compared with MT, were all significantly associated with the remission of T2DM and HbA1c levels. While BPD is the best one for remission (MD: -5.14 [95% CI -7.33 to -2.96]), HbA1c (MD: -31.75 [95% CI -37.73 to -25.77]), the evidence is sparse. RYGB was the most effective surgery type for BMI, TG, and DBP for the mid-term follow-up period. Moderate mid- and long-term effects of T2DM remission and HbA1c levels were observed after all surgical procedures. However, BPD appears to be promising for achieving long-term diabetes remission, HbA1c levels, and cardiometabolic profiles. RYGB is the most favourable option to manage HbA1c levels and BMI. The effects of other surgical types on cardiometabolic profiles are inconclusive and require further research.

Background: Sleeve gastrectomy (SG) is a common metabolic and bariatric surgery (MBS) with conflicting effects on gastroesophageal reflux disease (GERD), with some patients improving and others experiencing new or worsened GERD. This study investigated whether preoperative ambulatory 24-h pH monitoring (24-h pH) predicts postoperative GERD in patients undergoing SG, comparing GERD outcomes among those with normal, abnormal, and without preoperative 24-h pH.

Methods: A retrospective study was conducted on 120 patients (88.3% women, 38 ± 9 years, preoperative BMI 38.0 [36.4-40.6] kg/m²) who underwent SG between January 2017 and March 2022. Patients were subjected to clinical evaluation, including physical examination and anthropometric assessment, as well as upper gastrointestinal endoscopy (UGIE) at baseline and 12 months postoperatively. Preoperative 24-h pH was performed in a subset of patients, who were classified as normal (NG), abnormal (AG), and no monitoring (NMG) groups. Furthermore, GERD symptoms were evaluated postoperatively through the GERD questionnaire (Gerd-Q).

Results: At 12 months, the groups had a similar proportion of normal UGIE findings. Grade B esophagitis occurred in 7.5% of the NG vs. 25% of the AG. The NG exhibited lower Gerd-Q total scores and a smaller proportion of positive results compared with the NMG and the AG (2 [0-5] vs. 7 [0.5-18] and 5 [2-11.75]; 12.5% vs. 47.5% and 47.5%, respectively; p < 0.05 for all variables).

Conclusion: Postoperative GERD was more frequent in patients with abnormal or those without preoperative 24-h pH monitoring, whereas those with normal results in this test exhibited lower rates. These findings raise an important discussion regarding the role of 24-h pH monitoring before SG and its impact on clinical decision-making.

Background: Sleeve gastrectomy (SG) is effective but prone to late recurrent weight gain (RWG). Ring-augmented SG (Ra-SG) may preserve restriction and enhance long-term durability.

Methods: In this single-center, prospective, single-blind randomized trial, adults with a BMI > 50 kg/m² were randomized to SG or Ra-SG and followed for 36 months. The primary endpoint was percent total weight loss (%TWL) at 36 months. Secondary outcomes included RWG, gastric pouch volumetry, relapse of associated medical problems, complications, endoscopic findings, laboratory parameters, and patient-reported outcomes (SF-36, Suter).

Results: Ra-SG produced significantly greater weight loss at 36 months (48.8 ± 8.3 vs. 45.5 ± 9.0%TWL; mean difference 3.25% points, 95% CI 0.86 to 5.63; p 0.008). Exploratory analyses showed lower rates of clinically significant RWG (≥ 30% regain: 5.9% vs. 16.3%; absolute risk difference - 10.4%, 95% CI - 19.6 to - 1.2; p = 0.033) and smaller pouch volumes (160.1 ± 8.9 vs. 194.2 ± 10.3 mL; p < 0.001). Perioperative complications were infrequent and comparable. At three years, the prevalence of endoscopic GERD was similar (17.3% vs. 19.6%). Food tolerance scores were consistently better after SG (all p < 0.05). HRQoL improved significantly in both groups, with no differences observed at 36 months. Two Ra-SG patients (1.8%) underwent ring removal.

Conclusions: Ra-SG enhanced weight-loss durability and lowered RWG compared to SG, with similar safety and GERD outcomes but decreased food tolerance at mid-term. Ra-SG may be considered in patients at higher risk of RWG, though multicenter studies with longer follow-up are needed to confirm these findings.

Background: Obesity is associated with a range of medical problems, including impaired renal function. Type 2 diabetes mellitus (T2DM), independently, exerts a direct and multifactorial impact on renal health. This study evaluates and compares the effects of metabolic bariatric surgery (MBS) on renal function in patients with and without T2DM.

Methods: This prospective cohort study followed patients undergoing MBS over three years, stratified by T2DM status. Participants were matched using propensity scores (PS), and postoperative trajectories of creatinine-based estimated glomerular filtration rate (eGFR) were compared. Generalized estimating equation (GEE) method was employed to identify factors significantly associated with changes in eGFR over time.

Results: A total of 1895 participants (83% women), including 770 PS-matched individuals, were enrolled in the study. All participants had a baseline eGFR ≥ 60 mL/min/1.73m². Across both unmatched and matched cohorts, and irrespective of T2DM status, eGFR improved over the three-year follow-up, with no significant between-group differences or interactions observed. Multivariable analysis identified older age, being a woman, higher baseline eGFR, and undergoing sleeve gastrectomy (SG) as negative correlates of eGFR improvements over time.

Conclusion: Renal function improved following MBS, regardless of T2DM status. Furthermore, older age, being a woman, higher baseline eGFR, and undergoing SG were associated with less eGFR improvements.

Background: There is a continuous upward trend in the number of repeated metabolic bariatric surgeries (MBS) performed worldwide. In some cases, patients undergo a third or even higher-order MBS, yet there is a paucity of data regarding the clinical profiles of this population. This study aims to characterize the surgical history, anthropometric outcomes, and mental health profiles of patients seeking a third or higher-order MBS.

Methods: Between 2016 and 2021, candidates for a third or higher-order MBS underwent comprehensive evaluations by a clinical psychologist and a registered dietitian. Sociodemographic, psychological, and health data were collected from medical records, with psychological interviews conducted using a semi-structured DSM-5-based format.

Results: Data was collected from 99 candidates; 84 planned a third MBS, 14 a fourth, and one a fifth. The mean age and BMI were 47.8 years and 41.7 kg/m², respectively, and 80.8% were women. Most participants (95%) had undergone banding-based procedures as their primary MBS, and about 70% were converted to sleeve gastrectomy as a secondary MBS. Excess weight loss was lower after secondary compared to primary MBS (54.3 ± 47.4% vs. 64.9 ± 35.4%). High rates of psychopathology were observed, including depression (58.8%), anxiety (35.8%), post-traumatic stress disorder (58.5%), and 23.7% reported on psychiatric medication use.

Conclusions: This study illuminates a distinctive population of candidates seeking a third or higher-order BMS, revealing a notable prevalence of psychopathologies within this group. The findings underscore the importance of conducting further prospective studies to delve into clinical features associated with repeatable BMS.

Key points: • Third or higher-order MBS are increasingly performed worldwide. • Patients seeking repeated MBS often present with complex surgical histories. • Weight loss outcomes were less favorable after secondary vs. primary MBS. • High prevalence of psychopathology was observed in this unique population.

This study comprehensively analyzed scientific publications on metabolic and bariatric surgery in adolescents, using bibliometric methods to identify thematic trends and developments in the literature. Publications indexed in Web of Science, Scopus, and PubMed as of December 4, 2025, identified through the keyword combinations "adolescent" and "bariatric surgery," were analyzed using Biblioshiny (Bibliometrix) and VOSviewer. The dataset included 2,174 articles published between 1980 and 2025, and 62% were published after 2016. Obesity Surgery was the leading journal, and the USA contributed the largest share of publications (42.1%). Thematic evolution analysis revealed a paradigm shift from bariatric surgery to metabolic and bariatric surgery. This reflects a transition from an early focus on surgical techniques and weight loss to broader issues such as metabolic mechanisms, psychosocial outcomes, pharmacotherapy integration, and health disparities. The study highlights the multidimensional development of adolescent bariatric surgery research and may inform future research and practice. Multidisciplinary approaches targeting holistic care and reducing global inequalities are recommended. KEY POINTS: • The field has shifted from a technical focus on bariatric surgery to a holistic, biopsychosocial paradigm encompassing metabolic, psychological, pharmacotherapeutic, and social dimensions. • The USA is the leading contributor to the field and dominates publication output, institutional productivity, and author influence. • Obesity Surgery Journal is the most productive and influential journal and generates the highest volume of publications and citations.

Background: Sleeve gastrectomy (SG) is the most common bariatric procedure but requires revision in ~ 30% of cases due to suboptimal response or persistent obesity-related medical problems. Revisional options include re-sleeve gastrectomy, Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD/DS), and single-anastomosis duodenal switch (SADS), though long-term comparative data are limited.

Objectives: To assess medium- to long-term outcomes of four revisional surgeries after primary SG for suboptimal weight loss or persistent associated medical problems.

Setting: University hospital.

Methods: This retrospective study analyzed a prospectively maintained database of patients who underwent revisional bariatric surgery after SG between 2010 and 2021. Indications included suboptimal clinical response (< 50% excess weight loss), ≥ 20% recurrent weight gain, or persistent non-reflux obesity-related medical problems lasting ≥ 1 year. Revisions included re-sleeve, RYGB, BPD/DS, and SADS. Patients with ≥ 3 years of follow-up were evaluated for weight loss, associated medical problems resolution, and major complications.

Results: Of 113 eligible patients, 89 (79%) had ≥ 3 years of follow-up (median 70 [35] months). Median pre-revision BMI was 43.0 (8) kg/m², highest in duodenal switch-type procedures (p = 0.005). Median BMI reduction was 6.0 (7) kg/m². BPD/DS showed the highest median total weight loss (20% [12]) and diabetes resolution, though not statistically significant (p = 0.148 and 0.089). Major complications beyond 6 months were similar across groups (p = 0.248).

Conclusions: Revisional surgery after primary SG offers modest long-term benefits. Duodenal switch-type procedures show superior trends with comparable safety.

Background: Laparoscopic Adjustable Gastric Band (AGB) has shown suboptimal long-term results with a non-success rate of 20-56% with an accompanying removal rate of 10-50% due to suboptimal clinical response or complications. Conversion to RYGB is proven to be a safe and effective option. However, current literature contains no studies which use additional placement of a silicone ring (MiniMizer) around the pouch. Therefore, this study aims to evaluate the safety and effectiveness of conversion from AGB to ring augmented RYGB (raRYGB).

Methods: All consecutive laparoscopic AGB to raRYGB conversions performed between January 2016 and October 2023 were included. All procedures were performed by a one-stage approach. The primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of %TWL after 2, 3, 4, and 5 years, cumulative %TWL, and early and late complications.

Results: We included a total of 240 patients of whom 195 were female (81.3%). Mean pre-conversion BMI was 40.3 kg/m². The average %TWL 1- and 5-year after the conversion was 25.4% and 18.9%. Cumulative %TWL, calculated from before AGB, was 33.7% after 1 and 30.2% after 5 years. 8 complications occurred within 30 days, 3 of which were ≤ CD3a and 5 ≥ CD3b. A total of 8 MiniMizers were removed.

Conclusion: Conversion from laparoscopic AGB to raRYGB is a valid one-stage conversion method with significant weight loss after 1 and durable weight loss up to 5 years of follow-up. The short- and long-term complication rate is acceptable and ring-specific complications are rare.