Obesity Surgery最新文献

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.

Background: Chronotype reflects an individual's intrinsic circadian preference for the timing of daily behaviors, including sleep, eating, and physical activity. It influences not only biological rhythms but also lifestyle patterns that may impact metabolic health. In the context of bariatric surgery, numerous factors may affect postoperative outcomes such as weight loss and the risk of weight regain. Given the growing interest in chronobiology and its relevance to obesity management, this study aimed to explore whether chronotype is significantly associated with key weight loss outcomes following bariatric surgery at 6 and 12 months post-intervention.

Methods: A total of 263 patients underwent bariatric surgery at a single center. Baseline assessments included anthropometric, biochemical, and behavioral evaluations, including chronotype categorization. Postoperative outcomes at 6 and 12 months included absolute weight, BMI, percentage of initial body weight loss (%IBWL), and percentage of excess body weight loss (%EBWL).

Results: There was no significant difference among the three different chronotypes (evening, intermediate, and morning chronotype) in terms of absolute weight, BMI, %EWL and %IBWL at 6 and 12 months after surgery.

Conclusions: Our results suggest that chronotype does not seem to play a critical role in weight loss outcomes in bariatric surgery patients, characterized by severe obesity. Further studies are needed to more thoroughly assess the impact of chronotype on bariatric surgery outcomes and a more detailed characterization of chronotype itself in these patients could be decisive.

Introduction: The method for assessing the bowel length is debatable but crucial in bariatric surgeries, especially revisional ones. It may be linked to improved weight loss and reducing nutritional deficiencies; however, it can be time-consuming, increasing the likelihood of complications during and after the surgery. 3D CT volumetry could offer a non-invasive, time-saving alternative for accurate Total Bowel Length (TBL) measurement, potentially reducing operative time and associated risks.

Objective: This study compares small bowel length using 3D CT volumetry versus in vivo laparoscopic measurement with pre-marked graspers, and assesses the time consumed intra-operatively for TBL measurement in cases of revisional bariatric surgery.

Methods: This cross-sectional study included 34 bariatric surgery candidates undergoing revisional or conversion bariatric surgery requiring bowel length estimation. Surgeries included Roux-en-Y gastric bypass (RYGB), single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), one-anastomosis gastric bypass (OAGB), banded Roux-en-Y gastric bypass (banded RYGB), and distalization. Pre-operatively, 3D CT volumetry-based bowel length measurements were performed and interpreted by the same radiologist, and compared with intraoperative bowel measurements, which were estimated in vivo laparoscopically using pre-marked graspers. A single surgeon did all the surgical procedures.

Results: The participants had an average age of 42.0 years and a mean BMI of 40.4 ± 7.6 kg/m². The cohort was predominantly female (73.5%). The bowel length estimation took an average of 19 ± 4 min intra-operatively. A comparison of radiographic and intraoperative measurements showed no significant differences for TBL (P = 0.264). The intraclass correlation (ICC) for radiographic and intraoperative measurements showed that radiographic TBL shows acceptable consistency (P = 0.007).

Conclusion: 3D CT volumetry can be considered a reliable and safe method for TBL assessment. It aids in accurate preoperative planning, reduces operative time, and avoids the risks encountered during intraoperative bowel measurements in bariatric surgery.

Key points: • An ideal bowel length should achieve effective weight loss while minimizing nutritional deficiencies. • Estimation of total bowel length using 3D CT volumetry shows reliable results compared to intraoperative measurements. • Estimation of total bowel length using 3D CT volumetry minimizes operative time.

Background: The influence of preoperative psychological profiles on weight loss following sleeve gastrectomy (SG) has not been thoroughly examined, particularly with respect to sex differences.

Aim: To analyze the preoperative psychological profiles of individuals with obesity and explore whether sex differences exist in the associations between preoperative psychological factors and weight loss after SG.

Methods: This prospective cohort study involved participants scheduled for SG at an affiliated hospital between November 2020 and September 2022, with a follow-up period of 1-year post-surgery. Preoperative psychological profiles were assessed using validated scales, covering anxiety, depression, self-esteem, internalized weight bias, eating behaviors, sleep quality, and quality of life. Independent t-tests and Pearson correlation analyses were used to assess sex differences and associations between psychological factors and %TWL at 1-year post-surgery. Univariate and multivariate regression analyses were then performed to identify independent predictors of %TWL at 1-year post-surgery, with significance defined as p < .05.

Results: In total, 491 patients with obesity undergoing SG were enrolled, of whom 452 (314 women and 138 men) completed the study. Preoperatively, participants exhibited high levels of internalized weight bias, moderate alterations in eating behaviors, and poor sleep quality and quality of life. Compared to women, men demonstrated significantly lower levels of anxiety, depression, internalized weight bias, and emotional eating, but demonstrated significantly higher health transition scores (i.e., self-perceived improvement in general health compared to one year ago). Among women, 1-year postoperative weight loss was significantly positively associated with preoperative anxiety and internalized weight bias, but negatively associated with self-esteem and quality of life. Conversely, no statistically significant associations were found between preoperative psychological factors and weight loss outcomes in men. In multivariate regression analysis, no psychological factors independently predicted %TWL at 1-year post-surgery in women.

Conclusions: Sex differences were observed in the associations between preoperative psychological factors and weight loss after SG. Among women, psychological factors demonstrated stronger associations with weight loss after SG; however, none of these remained significant predictors in the multivariate regression model. No such associations were observed in males. These findings suggest that the impact of preoperative psychological factors on postoperative weight loss may be complex and merit further investigation.

Background: Metabolic bariatric surgery leads to improved life expectancy in younger individuals, but whether older (> 60 years) individuals benefit from metabolic bariatric surgery is uncertain. This study examined mortality and causes of death in patients with metabolic bariatric surgery at age 60 years or older.

Materials and methods: This was a population-based matched cohort study based on all healthcare in Denmark, Finland, and Sweden between 1996 and 2024. All patients who had primary metabolic bariatric surgery at age > 60 years were included and exactly matched 1:5 to comparison individuals of the same age, sex, country, and calendar year with non-operative treatment for obesity. Cox regression provided hazard ratios with 95% confidence intervals for mortality adjusted for multiple obesity-related diseases and frailty.

Results: In total, 3879 (16.7%) patients with metabolic bariatric surgery and 19395 (83.3%) patients with non-operative treatment for obesity were included and followed for 176632 person-years. The cumulative mortality was 17.5% (n = 677) among operated patients compared to 23.5% (n = 4536) in the non-operated. In adjusted analyses, metabolic bariatric surgery was associated with 32% decreased mortality (HR 0.68, 95% CI 0.63-0.73). The results were consistent in patients of age > 60-70 years at the time of surgery, but there was no apparent benefit in patients operated at age > 70 years (HR 1.14, 95% CI 0.89-1.47). Operated patients were less likely to die from cardiovascular disease (57.6% versus 65.8%, p < 0.001), but other causes of death were similarly distributed between the groups.

Conclusion: Metabolic bariatric surgery may decrease mortality in older patients with severe obesity.