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Risk and Characteristics of Constipation After Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis. 代谢和减肥手术后便秘的风险和特征:系统回顾和荟萃分析。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-02 DOI: 10.1007/s11695-025-08457-5
Chenglou Zhu, Wenhan Liu

Background: Constipation is a common yet often underrecognized gastrointestinal complication following metabolic and bariatric surgery (MBS). It not only affects patients' quality of life but may also lead to abdominal pain, bowel obstruction, and nutrient malabsorption. However, current findings regarding its incidence, risk factors, and variations across surgical procedures remain inconsistent.

Objective: To comprehensively assess the risk of postoperative constipation, its procedure-specific differences, and related clinical characteristics after MBS, providing evidence-based insights for postoperative management and intervention.

Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was prospectively registered in PROSPERO (Registration No. CRD 420251162054 ). A comprehensive search was conducted in PubMed, Embase, Web of Science, MEDLINE, and the Cochrane Library up to October 2025. Studies reporting constipation outcomes after MBS were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model, and subgroup analyses were performed based on surgical type.

Results: Eight studies comprising 4,838 participants were included. The pooled analysis demonstrated no significant association between MBS and constipation risk (OR = 1.04, 95% CI: 0.62-1.73, p = 0.83), with substantial heterogeneity (I² = 82.9%). Subgroup analyses revealed procedure-dependent differences: biliopancreatic diversion (BPD) (OR = 0.19, 95% CI: 0.07-0.52) and Roux-en-Y gastric bypass (RYGB) (OR = 0.12, 95% CI: 0.04-0.38) were associated with a reduced risk, whereas adjustable gastric banding (AGB) significantly increased constipation risk (OR = 2.40, 95% CI: 1.08-5.33).Results for laparoscopic sleeve gastrectomy (LSG) were heterogeneous, with pooled data showing no significant association (OR = 1.31, 95% CI: 0.62-2.77). Sensitivity analyses and publication bias assessments confirmed the robustness of the findings.

Conclusions: The risk of constipation following MBS is strongly procedure-dependent. Malabsorptive or mixed procedures (e.g., BPD, RYGB) may lower constipation risk, whereas restrictive procedures (e.g., AGB) appear to increase it. LSG shows no consistent association. Individualized postoperative management-including adequate dietary fiber and fluid intake, maintenance of regular bowel habits, and early preventive interventions-may improve postoperative quality of life. Further large-scale, multicenter, prospective studies are needed to elucidate the underlying mechanisms and refine postoperative care strategies.

背景:便秘是代谢和减肥手术(MBS)后常见但常被忽视的胃肠道并发症。它不仅影响患者的生活质量,还可能导致腹痛、肠梗阻和营养吸收不良。然而,目前关于其发病率、危险因素和外科手术差异的研究结果仍不一致。目的:综合评价MBS术后便秘风险、手术特异性差异及相关临床特征,为术后管理和干预提供循证见解。方法:本系统评价和荟萃分析遵循PRISMA指南,并在PROSPERO(注册号:1)前瞻性注册。CRD 420251162054)。在PubMed, Embase, Web of Science, MEDLINE和Cochrane Library进行了全面的搜索,截止到2025年10月。研究报告了MBS后便秘的结果。采用随机效应模型计算95%置信区间(ci)的合并优势比(ORs),并根据手术类型进行亚组分析。结果:纳入8项研究,共4838名受试者。合并分析显示MBS与便秘风险无显著相关性(OR = 1.04, 95% CI: 0.62-1.73, p = 0.83),存在显著异质性(I²= 82.9%)。亚组分析显示了手术依赖性差异:胆管分流(BPD) (OR = 0.19, 95% CI: 0.07-0.52)和Roux-en-Y胃旁路(RYGB) (OR = 0.12, 95% CI: 0.04-0.38)与便秘风险降低相关,而可调节胃束带(AGB)显著增加便秘风险(OR = 2.40, 95% CI: 1.08-5.33)。腹腔镜袖式胃切除术(LSG)的结果是异质性的,合并数据显示无显著相关性(OR = 1.31, 95% CI: 0.62-2.77)。敏感性分析和发表偏倚评估证实了研究结果的稳健性。结论:MBS后便秘的风险与手术过程密切相关。吸收不良或混合手术(如BPD、RYGB)可能降低便秘风险,而限制性手术(如AGB)似乎会增加便秘风险。LSG显示没有一致的关联。个体化的术后管理——包括充足的膳食纤维和液体摄入,维持规律的排便习惯,以及早期预防干预——可能改善术后生活质量。需要进一步的大规模、多中心、前瞻性研究来阐明潜在的机制和完善术后护理策略。
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引用次数: 0
Outcomes of Bariatric Surgery for Idiopathic Intracranial Hypertension: A Systematic Review and a Single-Arm Meta-analysis. 特发性颅内高压减肥手术的结果:一项系统评价和单组荟萃分析
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-02 DOI: 10.1007/s11695-025-08447-7
Julia Bueno de Oliveira Alves, Pedro Bicudo Bregion, Gabriel José Souto Maior de França, Luísa Zanelatto de Araújo, Giovanna Macanhã Scremin, Pandora Eloa Oliveira Fonseca, Leonardo Halamy Pereira, João Gabriel Romero Braga, Victor Kenzo Ivano, Everton Cazzo
<p><strong>Background and aims: </strong>Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure (ICP) in the absence of structural pathology and is strongly linked to obesity. Weight reduction remains the only disease-modifying therapy, and bariatric surgery (BS) may offer durable ICP control and symptom improvement. This study evaluated postoperative clinical, visual, and physiological outcomes in patients with IIH undergoing BS.</p><p><strong>Methods: </strong>A systematic review and single-arm meta-analysis were conducted in accordance with PRISMA and Cochrane guidelines. PubMed, Embase, and CENTRAL were searched through April 2025. Eligible studies included obese patients with IIH who underwent any bariatric procedure. Primary outcomes were remission of headache, papilledema, pulsatile tinnitus, and cessation of IIH-related medications. Secondary outcomes included changes in visual parameters, weight loss, BMI reduction, and CSF opening pressure. Risk of bias was assessed with ROBINS-I for observational studies and RoB-2 for randomized trials. Heterogeneity was explored through leave-one-out analyses, Baujat influence plots, and meta-regression.</p><p><strong>Results: </strong>Nine studies (eight observational, one randomized clinical trial) comprising 229 patients were included. Patients were predominantly women with severe obesity (BMI 40.4-49.0 kg/m²) and markedly elevated baseline CSF pressures (32-45 cmH₂O). Pooled estimates demonstrated high rates of improvement across outcomes, including headache (84.6%), visual field deficits (83.3%), pulsatile tinnitus (88.7%), and visual symptoms (98.1%). Papilledema resolution approached 98% but showed wide prediction intervals due to small samples and complete-event studies. Medication cessation occurred in 63.3% of patients. CSF pressure decreased significantly (mean - 13.24 cmH₂O), and total weight loss averaged 28.5%, with excess weight loss of 65.7%. Meta-regression indicated that higher baseline CSF pressure and higher proportions of RYGB predicted greater CSF reduction, while preoperative BMI and the proportion of SG significantly moderated postoperative weight loss. Influence diagnostics identified Wills et al. and Lainas et al. as key contributors to heterogeneity in symptom and medication outcomes, and Mollan et al. as the principal driver of variability in weight-loss estimates. Reported complications were infrequent and predominantly mild, and no deaths were noted, although follow-up completeness varied. Risk of bias was low in the randomized trial but moderate to serious in the observational cohorts.</p><p><strong>Conclusion: </strong>Bariatric surgery in patients with IIH is associated with favorable postoperative outcomes, including high rates of symptom improvement and reduced medication use. While these findings support the potential disease-modifying role of surgical weight loss, they should be interpreted with caution given the single-arm na
背景和目的:特发性颅内高压(IIH)在没有结构性病理的情况下以颅内压(ICP)升高为特征,与肥胖密切相关。减肥仍然是唯一的疾病改善治疗,减肥手术(BS)可能提供持久的ICP控制和症状改善。本研究评估了IIH患者接受BS手术后的临床、视觉和生理结果。方法:按照PRISMA和Cochrane指南进行系统评价和单臂荟萃分析。PubMed, Embase和CENTRAL的检索截止到2025年4月。符合条件的研究包括接受任何减肥手术的IIH肥胖患者。主要结局是头痛、乳头水肿、搏动性耳鸣的缓解,以及iih相关药物的停止。次要结局包括视力参数改变、体重减轻、BMI降低和脑脊液开口压。观察性研究采用robins - 1评估偏倚风险,随机试验采用robins -2评估偏倚风险。通过遗漏分析、Baujat影响图和元回归来探索异质性。结果:纳入9项研究(8项观察性研究,1项随机临床试验),共229例患者。患者主要是严重肥胖的女性(BMI为40.4-49.0 kg/m²),基线脑脊液压力明显升高(32-45 cmH₂O)。综合估计结果显示,包括头痛(84.6%)、视野缺损(83.3%)、搏动性耳鸣(88.7%)和视觉症状(98.1%)在内的预后均有较高的改善率。乳头水肿的分辨率接近98%,但由于小样本和完整事件研究,预测间隔较宽。63.3%的患者停药。脑脊液压力显著下降(平均- 13.24 cmH₂O),总体重平均下降28.5%,超重体重下降65.7%。meta回归显示,较高的基线脑脊液压力和较高的RYGB比例预示着更大的脑脊液减少,而术前BMI和SG比例显著减缓了术后体重减轻。影响诊断确定Wills等人和Lainas等人是导致症状和用药结果异质性的关键因素,而Mollan等人则是导致体重减轻估计差异的主要因素。报告的并发症很少,主要是轻微的,没有死亡记录,尽管随访的完整性各不相同。在随机试验中偏倚风险较低,但在观察队列中偏倚风险中等至严重。结论:IIH患者的减肥手术与良好的术后结果相关,包括高症状改良率和减少药物使用。虽然这些发现支持手术减肥的潜在疾病改善作用,但考虑到现有证据的单臂性质和观察性研究的优势,应谨慎解释。
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引用次数: 0
Metabolic and Bariatric Surgery Evolution Over the Past Decades (2009-2024): Insights from the Iranian National Obesity Surgery Database (INOSD). 代谢和减肥手术在过去几十年的发展(2009-2024):来自伊朗国家肥胖手术数据库(INOSD)的见解。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-02 DOI: 10.1007/s11695-025-08444-w
Shahab Shahabi Shahmiri, Abdolreza Pazouki, Seyed Amin Setarehdan, Kimia Vakili, Kimia Jazi, Erfan Sheikhbahaei, Fahime Yarigholi, Somayeh Mokhber, Alireza Khalaj, Amir Hossein Davarpanah Jazi, Mohammad Kermansaravi

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.

背景:在过去的三十年中,代谢和减肥手术(MBS)在伊朗发生了重大变化,反映了全球趋势并结合了区域创新。本研究旨在调查伊朗15年来(2009-2024年)的MBS趋势,重点关注人口模式和程序分布。方法:来自伊朗国家肥胖手术数据库(INOSD)的数据为回顾性研究提供了基础。该研究涵盖了2009年至2024年间所有MBS患者。分析了人口统计学特征、体重指数(BMI)、肥胖相关疾病、手术类型和随时间变化的趋势。结果:共纳入55,936例患者,以女性居多(80%)。大多数(62%)年龄在25-45岁之间。随着时间的推移,BMI在50 kg/m²以下的患者数量下降,大多数患者的BMI在40-50 kg/m²之间。最常见的与肥胖相关的医学问题是高血压(15%)、严重阻塞性睡眠呼吸暂停(12%)、2型糖尿病(11%)和血脂异常(11%)。袖胃切除术(SG)从2009年的2.6%上升到2024年的56%,超过了Roux-en-Y胃旁路术(RYGB),后者从2009年的92%下降到2024年的13%。特别是在高BMI患者中,一个吻合胃旁路(OAGB)显示出持续的上升。随着时间的推移,修正和转换手术的比率上升,特别是在OAGB中。结论:随着对SG和OAGB倾向的增加,伊朗的MBS趋势反映了世界范围内更安全和更有效治疗的趋势。
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引用次数: 0
Impact of Bariatric Surgery on Gout Medication: a Nationwide Cohort Study. 减肥手术对痛风药物治疗的影响:一项全国性队列研究。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-02 DOI: 10.1007/s11695-025-08445-9
Yeongkeun Kwon, Jaechan Park, Dohyang Kim, Jinseub Hwang, Soo Min Jeon, Jin-Won Kwon

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.

背景:虽然减肥手术(BS)是治疗病态肥胖患者痛风的有效方法,但对于BS如何影响痛风药物的后续使用知之甚少。我们调查了BS对痛风药物使用的影响。方法:这项回顾性全国队列研究使用了来自韩国的数据,包括2019-2020年接受BS治疗的所有患者。采用倾向评分匹配法建立对照组。主要结局是使用痛风药物的患者比例的变化,这些药物被分类为降尿酸治疗(ULT)或急性药物。我们使用Cox回归评估BS后停药和重新开始用药的风险比。结果:该研究包括3804名BS组参与者和15240名倾向评分匹配的对照组。术后3年,从第13个月开始,BS组的ULT使用率下降到与对照组相当,BS组更有可能停药(调整后的风险比为1.80;95%可信区间为1.37-2.37)。相比之下,虽然BS后急性用药也有所减少,但其发生率仍高于对照组,停药无显著差异。同样,3年内痛风药物重新开始的比率在两组之间没有显著差异。结论:BS后3年多,BS组痛风药物的总体使用下降到与对照组相当的水平,且ULT停药率明显较高。急性痛风药物停药没有显著差异。
{"title":"Impact of Bariatric Surgery on Gout Medication: a Nationwide Cohort Study.","authors":"Yeongkeun Kwon, Jaechan Park, Dohyang Kim, Jinseub Hwang, Soo Min Jeon, Jin-Won Kwon","doi":"10.1007/s11695-025-08445-9","DOIUrl":"https://doi.org/10.1007/s11695-025-08445-9","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the Editor: Outcomes and Safety of One Anastomosis Gastric Bypass (OAGB): A Three-Year Retrospective Study. 致编辑:一项为期三年的回顾性研究:一次胃旁路吻合(OAGB)的结果和安全性。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-01 Epub Date: 2025-09-08 DOI: 10.1007/s11695-025-08250-4
Weikang Xu, Xinyang Xia
{"title":"Letter to the Editor: Outcomes and Safety of One Anastomosis Gastric Bypass (OAGB): A Three-Year Retrospective Study.","authors":"Weikang Xu, Xinyang Xia","doi":"10.1007/s11695-025-08250-4","DOIUrl":"10.1007/s11695-025-08250-4","url":null,"abstract":"","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":"359-360"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on "Complementary Roles of PCT, CRP, WBC, and ΔWBC in Early Leak Detection After Bariatric Surgery: A Retrospective Pilot Study". “PCT、CRP、WBC和ΔWBC在减肥手术后早期泄漏检测中的补充作用:一项回顾性试点研究”。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-01 Epub Date: 2025-09-02 DOI: 10.1007/s11695-025-08233-5
Manish R Bhise, Nitin Motiram Gawai, Ashish B Wadekar
{"title":"Comment on \"Complementary Roles of PCT, CRP, WBC, and ΔWBC in Early Leak Detection After Bariatric Surgery: A Retrospective Pilot Study\".","authors":"Manish R Bhise, Nitin Motiram Gawai, Ashish B Wadekar","doi":"10.1007/s11695-025-08233-5","DOIUrl":"10.1007/s11695-025-08233-5","url":null,"abstract":"","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":"353-354"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extremely Early Ambulation after Bariatric and Metabolic Surgery: A Randomized Controlled Trial. 减肥和代谢手术后极早期活动:一项随机对照试验。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-01 Epub Date: 2025-11-24 DOI: 10.1007/s11695-025-08387-2
Hang Bao, Guanyu Yang, Shumin Tu, Shikun Huang, Shuling Liu, Xiaoni Qin, Qinjun Chu

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.

背景:代谢减肥手术(MBS)后常见的胃肠功能障碍(POGD),延长了住院时间,增加了费用。虽然《术后增强恢复指南》(ERAS)建议在术后第一天进行活动,但支持麻醉后护理病房(PACU)极早开始活动的证据仍然有限。目的:评价在PACU启动的结构化、分级行走方案是否在不增加不良事件的情况下缩短腹腔镜袖胃切除术(LSG)后首次放屁的时间,并评估其对恢复质量的影响。方法:这是一项单中心、评估盲、随机对照试验。92例患者被随机分为实验组(PACU行走)和对照组(常规病房行走)。实验组遵循PACU到达时开始的结构化三步方案(坐、站、走)。主要观察指标为首次排气时间(小时)。次要结局包括恢复质量-15(QoR-15)评分、疼痛评分(VAS)、阿片类药物消耗(吗啡当量)、腹胀和安全性结局(PONV、直立性低血压)。结果:实验组首次放屁时间明显短于对照组(中位数18.6h[IQR 9.9 ~ 22.7]vs.24.0h[IQR 19.5 ~ 28.8];中位数差-5.4h, 95%CI: -7.6 ~ 3.2; P< 0.001)。实验组患者术后第一天POD0(中位数122.0vs.105.0,P< 0.001)、POD1(中位数135.0vs.122.0,P < 0.001)、POD2(中位数140.0 vs. 134.0, P< 0.001) QoR-15评分均显著高于对照组。实验组POD 0 QoR-15的相对下降幅度较小(13.5%比26.6%)。两组间不良事件发生率无显著差异。结论:在PACU中启动的结构化分级活动方案安全地缩短了首次放屁的时间,并提高了LSG后的恢复质量,可能是通过胆碱能抗炎和重力机制。本研究为将标准化的早期动员方案整合到MBS患者的ERAS通路中提供了高质量的证据。
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引用次数: 0
Primary Care Providers Perspectives of GLP-1 Receptor Agonists to Manage Recurrent Weight Gain after Metabolic Bariatric Surgery - a Qualitative Study. 初级保健提供者对GLP-1受体激动剂治疗代谢减肥手术后复发性体重增加的看法-一项定性研究。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-01 Epub Date: 2025-11-26 DOI: 10.1007/s11695-025-08408-0
Liisa Tolvanen, Karin Mossberg, Lindsey M Grace, Erin C Standen, Sean M Phelan, Daniel P Andersson, Afton M Koball

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.

导言:代谢减肥手术(MBS)后复发性体重增加影响了20-25%的患者,研究表明高达87%的患者在MBS后体重增加。胰高血糖素样肽-1受体激动剂(GLP-1RAs)在初级保健中越来越多地用于控制肥胖。然而,在了解初级保健提供者(pcp)对MBS背景下GLP-1RAs的看法方面仍然存在差距。方法:在这项定性研究中,我们招募了来自美国和瑞典的初级保健提供者(pcp) (n = 38),他们在MBS后有提供初级保健服务的经验。个人半结构化访谈在2024年9月至2025年3月期间进行。我们用反身性主题分析对采访记录进行分析。结果:主要主题“GLP-1RAs -在突破和不确定性之间导航”捕获了pcp对GLP-1RAs的出现是有益的看法,同时描述了他们在mbs后护理中使用GLP-1RA的不确定性。pcp欢迎出现一种新的工具来解决反复出现的体重增加。然而,由于系统障碍,患者对GLP-1RAs的要求引起了对初级保健处方资源和获取的担忧。pcp确定需要更多的GLP-1RA使用后mbs的知识和经验。他们还认识到MBS在治疗肥胖方面的作用正在发生变化。结论:pcp认为GLP-1RAs是解决MBS后复发性体重增加的有希望和有效的工具,并且患者的护理选择得到了改善。系统障碍被认为对治疗效果有负面影响。需要更多的专家指导和支持,以有效治疗MBS后GLP-1RAs患者。
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引用次数: 0
Comment on "The Role of the BMI ≥ 40 kg/m2 Criterium in ASA-PS Classification for Metabolic and Bariatric Surgery (MBS)". 对“BMI≥40 kg/m2标准在代谢和减肥手术(MBS) ASA-PS分级中的作用”的评论
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-01 Epub Date: 2025-09-08 DOI: 10.1007/s11695-025-08261-1
Koyel Roy, Jiyauddin Dr, Sunita Banerjee, Rachana Mehta
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引用次数: 0
Comment on "Feasibility of Online Cognitive-behavioral Group Therapy Following Metabolic Bariatric Surgery: A Randomized Pilot Study". 对“代谢性减肥手术后在线认知行为团体治疗的可行性:一项随机试点研究”的评论。
IF 3.1 3区 医学 Q1 SURGERY Pub Date : 2026-01-01 Epub Date: 2025-09-03 DOI: 10.1007/s11695-025-08255-z
Sri Kanth Marthandam, Monica Arora, Sudarshana Borah
{"title":"Comment on \"Feasibility of Online Cognitive-behavioral Group Therapy Following Metabolic Bariatric Surgery: A Randomized Pilot Study\".","authors":"Sri Kanth Marthandam, Monica Arora, Sudarshana Borah","doi":"10.1007/s11695-025-08255-z","DOIUrl":"10.1007/s11695-025-08255-z","url":null,"abstract":"","PeriodicalId":19460,"journal":{"name":"Obesity Surgery","volume":" ","pages":"363-364"},"PeriodicalIF":3.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Obesity Surgery
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