Background: Over the past three decades, metabolic and bariatric surgery (MBS) has undergone significant changes in Iran, mirroring global trends and incorporating regional innovations. This study aims to investigate MBS trends in Iran over 15 years (2009-2024), with a focus on demographic patterns and procedural distribution.
Methods: Data from the Iranian National Obesity Surgery Database (INOSD) provided the basis for a retrospective study. The study encompassed all patients with MBS between 2009 and 2024. The demographic traits, body mass index (BMI), obesity-associated medical disease, surgical operation type, and trends over time were analyzed.
Results: In total, 55,936 patients were included, most of whom were female (80%). The majority (62%) were aged 25-45 years. With a declining number of patients with BMI > 50 kg/m² over time, most patients fell in the range of 40-50 kg/m². The most common obesity-associated medical problems were hypertension (15%), severe obstructive sleep apnea (12%), type 2 diabetes mellitus (11%), and dyslipidemia (11%). Rising from 2.6% in 2009 to 56% in 2024, sleeve gastrectomy (SG) surpassed Roux-en-Y gastric bypass (RYGB), which decreased from 92% in 2009 to 13% in 2024. Especially in higher BMI patients, one anastomosis gastric bypass (OAGB) demonstrated a consistent rise. Rates of revisional and conversional surgery rose over time, specifically in OAGB.
Conclusions: With an increasing inclination for SG and OAGB, MBS trends in Iran mirror a worldwide movement toward safer and more effective treatments.
Background: While bariatric surgery (BS) is an effective treatment for gout in patients with morbid obesity, little is known about how BS influences subsequent use of gout medications. We investigated the impact of BS on gout medication use.
Methods: This retrospective nationwide cohort study used data from South Korea, including all patients who underwent BS in 2019-2020. A control group was created using propensity score matching. The primary outcome was the change in the proportion of patients using gout medications, categorized as urate-lowering therapy (ULT) or acute medications. We assessed hazard ratios for discontinuation and reinitiation of medications after BS using Cox regression.
Results: The study included 3804 participants in the BS group and 15,240 propensity score-matched controls. Over the 3 years after surgery, ULT use in the BS group declined to rates comparable to those in controls from month 13 onward, and discontinuation was more likely in the BS cohort (adjusted hazard ratio, 1.80; 95% confidence interval, 1.37-2.37). In contrast, although acute medication use also decreased after BS, its rate remained higher than in controls, and discontinuation did not differ significantly. Similarly, the 3-year rate of gout medication reinitiation did not differ significantly between groups.
Conclusions: Over 3 years after BS, overall gout medication use in the BS group declined to a level comparable to that in controls, with a significantly higher ULT discontinuation rate. Discontinuation of acute gout medications did not differ significantly.
Background: Postoperative gastrointestinal dysfunction (POGD) is common after metabolic bariatric surgery (MBS), prolonging hospitalization and increasing costs. While Enhanced Recovery After Surgery (ERAS) guidelines recommend ambulation on postoperative day one, evidence supporting extremely early ambulation commencing in the post-anesthesia care unit (PACU) remains limited.
Objective: To evaluate whether a structured, graded ambulation protocol initiated in the PACU shortens the time to first flatus after laparoscopic sleeve gastrectomy (LSG) without increasing adverse events, and to assess its impact on recovery quality.
Methods: This was a single-center, assessor-blinded, randomized controlled trial. 92 patients scheduled for elective LSG were randomized to either the experimental group (PACU ambulation) or the control group (conventional ward ambulation). The experimental group followed a structured 3-step protocol (sitting, standing, walking) initiated upon PACU arrival. The primary outcome was time to first flatus (hours). Secondary outcomes included Quality of Recovery-15(QoR-15) scores, pain scores (VAS), opioid consumption (morphine equivalents), abdominal distension, and safety outcomes (PONV, orthostatic hypotension).
Results: Time to first flatus was significantly shorter in the experimental group compared to the control group (median18.6h[IQR 9.9-22.7]vs.24.0h[IQR 19.5-28.8]; median difference -5.4h, 95%CI: -7.6to-3.2; P< 0.001). QoR-15 scores were significantly higher in the experimental group on postoperative day POD0(median122.0vs.105.0,P< 0.001), POD1(135.0vs.122.0,P < 0.001), and POD2 (140.0 vs. 134.0, P < 0.001). The relative decline in QoR-15 on POD 0 was smaller in the experimental group (13.5% vs. 26.6%). There were no significant differences in adverse events between groups.
Conclusion: A structured graded ambulation protocol initiated in the PACU safely reduces the time to first flatus and improves the quality of recovery after LSG, potentially via cholinergic anti-inflammatory and gravitational mechanisms. This study provides high-quality evidence for integrating standardized early mobilization protocols into ERAS pathways for MBS patients.
Introduction: Recurrent weight gain after metabolic bariatric surgery (MBS) affects 20-25% of patients, with research indicating that up to 87% of patients experience some post-MBS weight gain. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being used to manage obesity in primary care. However, there remains a gap in understanding primary care providers (PCPs) perspectives on GLP-1RAs in the context of MBS.
Methods: For this qualitative study, we recruited primary care providers (PCPs) (n = 38) from the United States and Sweden who had experience providing healthcare services in primary care after MBS. Individual semi-structured interviews were conducted between September 2024 and March 2025. We analyzed the transcribed interviews with reflexive thematic analysis.
Results: The primary theme "GLP-1RAs - Navigating Between Breakthrough and Uncertainty" captures PCPs' perception of the advent of GLP-1RAs as beneficial, while characterizing their uncertainty regarding GLP-1RA use in post-MBS care. PCPs welcomed the emergence of a new tool to address recurrent weight gain. However, patient requests for GLP-1RAs raised concerns about primary care prescription resources and access due to systematic barriers. PCPs identified a need for more knowledge and experience with GLP-1RA use post-MBS. They also recognized the changing role of MBS in treating obesity.
Conclusion: PCPs perceived GLP-1RAs as a promising and effective tool for addressing recurrent weight gain after MBS, and that care options for patients had improved. Systematic barriers were perceived to have a negative impact on the effectiveness of treatment. More expert guidance and support to effectively treat patients with GLP-1RAs after MBS is needed.
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